Benign scrotal masses in children – some new lessons learned

Friend, Jikol; Barker, Andrew; Khosa, Japinder; Samnakay, Naeem

doi:10.1016/j.jpedsurg.2016.07.016

Cited by 26 publications

(38 citation statements)

References 27 publications

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“…This protocol is useful also for centres were the frozen section is not available: very small lesions could be managed with definitive histology and any subsequent decision can be delayed. In our experience, intraoperative histology on frozen section was possible in 8 of 10 small nodules with diameter less than 8 mm, Testis sparing surgery is adopted also in selected cases in children (9). During surgery the surgeon should use loop for optical magnification and use palpation to detect the nodule.…”

Section: Discussionmentioning

confidence: 93%

Testicular sparing surgery in small testis masses: A multinstitutional experience

Galosi

Fulvi

Fabiani

et al. 2016

Arch Ital Urol Androl

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Introduction: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. Materials and methods: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397) which comprises: 1) testicular tumor markers, 2) repeated scrotal ultrasound at the tertiary center, 3) surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. Results: Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15). Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3%) with immediate radical orchiectomy and 17/28 (60.7%) with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma), benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma), benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis), and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. Conclusions: The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single testicular nodules below 15 mm is a safe option, but requires a standardized pathway in diagnosis. Our pathway has shown good reliability and security profile to be applied in a multicenter management for small scrotal masses. Our study has shown the reliability of the diagnostic-therapeutic pathway in the management of single testicular masses. The higher incidence of benign lesions in 60% of patients makes often orchiectomy an overtreatment.

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Section: Discussionmentioning

confidence: 93%

Testicular sparing surgery in small testis masses: A multinstitutional experience

Galosi

Fulvi

Fabiani

et al. 2016

Arch Ital Urol Androl

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“…In a study by Friend et al 7, TSS was recommended as standard treatment for epidermoid cysts, however, it was not recommended for follow-up of patients with testicular epidermoid cyst. In one case, orchiectomy was performed because of the fact that distinguishing malignant from benign tumor could not be made in frozen examination (7). In their study, Bujons et al (8) reported that 15 children in pre-pubertal period underwent TSS and 4 patients had epidermoid cysts.…”

Section: Discussionmentioning

confidence: 99%

Testis Sparing Surgery in Children

Şahan¹,

Guctas²,

Atabay³

et al. 2019

jus

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Çocuklarda testis tümörünün standart tedavisi radikal orşiektomi olmasına rağmen tümör boyutları, belirteçleri ve histopatolojik bulgulara göre uygun olgularda testis koruyucu cerrahi (TKC) alternatif bir yöntemdir. Bu olgu sunumunda yaşları 11 ve 12 olan TKC uygulanan iki hastanın sunulması amaçlanmıştır. İki hastada da frozen incelemesi yapılmıştır. Bir hastada peroperatif ultrasonografi eşliğinde kitle eksizyonu yapılmıştır. Histopatolojik incelemede bir hastada epidermoid kist ve diğer hastada leydig hücre hiperplazisi olarak raporlanmıştır. Testis koruyucu cerrahi küçük testis kitlesi ve negatif tümör belirteçleri olan çocuklarda uygulanabilir.

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“…In één casus is een recidief epidermoïdcyste beschreven na testissparende chirurgie [15]. Tot op heden is nooit beschreven of er een relatie is tussen een epidermoïdcyste en een (pre)maligne afwijking in de testis.…”

Section: Discussieunclassified

Case report. Een benigne zwelling van de testis: een intratesticulaire epidermoïdcyste. Cave: overige echografische afwijkingen

et al. 2018

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Samenvatting Deze casus betreft een 22-jarige patiënt die zich presenteerde met een niet-pijnlijke, palpabele zwelling van de linker testis. Echografie toonde een typisch beeld met uienringen, met daarnaast een tweetal kleine hypo-echogene laesies als toevalsbevinding. Patiënt onderging daarom een radicale orchidectomie links. Pathologie bevestigde de diagnose 'intratesticulaire epidermoïdcyste', er werd echter ook een seminoom gevonden. Een intratesticulaire epidermoïdcyste is de meest voorkomende afwijking van de testis. Echografie is eerste keus in de diagnostiek, maar hiermee kan de diagnose niet met zekerheid worden gesteld, aangezien een matuur teratoom dezelfde echografische kenmerken kan hebben. Indien er sprake is van alleen een epidermoïdcyste zou kunnen worden volstaan met een afwachtend beleid of een partiële resectie. In het kader van deze casus was een radicale orchidectomie achteraf de juiste keuze, aangezien er ook sprake was van een seminoom. Trefwoorden intratesticulaire epidermoïdcyste • testis • benigne Case report. A benign tumor of the testis: an intratesticular epidermoid cyst. Preserve you from other ultrasound abnormalities Abstract A 22-year-old patient visited our outpatient clinic with a non-painful, palpable swelling of the left testis. Ultrasonography showed suspicion of an intratesticular epidermoid cyst with a hypoechogenic lesion located next to it. The patient underwent a radical orchiectomy. Pathology showed an intratesticular epidermoid cyst and also a small seminoma. An intratesticular epidermoid cyst is the most seen, benign abnormality of the testis. Ultrasound of the testis is the first choice of diagnostics and shows a characteristic onion ring like pattern. Treatment options are follow-up or partial resection. In this specific case, a radical orchiectomy was the good choice because of the seminoma found in the specimen. Keywords intratesticular epidermoid cyst • testis • benign Introductie Een zwelling van het scrotum is een afwijking die dagelijks in de praktijk beoordeeld wordt (bijvoorbeeld een hydrocele drs. Diederick Duijvesz

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Benign scrotal masses in children – some new lessons learned

Cited by 26 publications

References 27 publications

Testicular sparing surgery in small testis masses: A multinstitutional experience

Testicular sparing surgery in small testis masses: A multinstitutional experience

Testis Sparing Surgery in Children

Case report. Een benigne zwelling van de testis: een intratesticulaire epidermoïdcyste. Cave: overige echografische afwijkingen

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