Benign Testicular Tumors: A Case for Testis Preservation?

Kressel, K; Schnell, David; Wf, Thon; B, Heymer; Hartmann, Michael; Je, Altwein

doi:10.1159/000473433

Cited by 24 publications

(10 citation statements)

References 14 publications

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“…The tumour is bilateral in 3-10% of patients [5,6]. The aetiology of LCTs is unknown and literature mostly describes a benign course of disease, but metastasic disease exists and sometimes it is difficult to differentiate histologically between malignant and benign forms [7][8][9]. Usually LCTs are small, solid and hypoechoic on ultrasound [2].…”

Section: Introductionmentioning

confidence: 99%

Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques

Leonhartsberger¹,

Ramoner²,

Stoehr³

et al. 2011

BJU International

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Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Leydig cell tumours (LCTs) of the testis are rare tumours, accounting for 1–3% of all testicular neoplasms. Our data indicate that using scrotal ultrasound with high resolution imaging in routine checkups leads to an earlier detection of LCTs. Most patients underwent an organ‐sparing surgery and no androgen deprivation was observed. OBJECTIVE • To report an observed high frequency of Leydig cell tumours (LCTs) diagnosed at our centre. PATIENTS AND METHODS • Charts of all patients who underwent surgery for a testicular tumour between 1999 and 2008 at our department were searched and data from patients with LCT were collected. • Before surgery all patients underwent ultrasound and complete staging. In all but two patients with LCT an organ‐sparing surgery was performed. Surgery was performed under ultrasound or palpation guidance. • All patients underwent postoperative follow‐up. We retrospectively reviewed surgical technique, histology, epidemiology and outcome in all LCT patients. RESULTS • In the study period, 197 testicular tumours were surgically removed of which 29 were diagnosed as LCT (14.7% of 197; further study group) in 25 patients. Mean age of patients with LCT was 45 years (range 21–68 years). • Tumour size ranged from 1.2 to 80 mm (mean 10.23 mm). In two patients (8%) the lesion was palpable whereas incidental diagnosis was made in seven patients (28%). • In the remaining patients diagnosis was made by ultrasound performed for testicular pain (six patients, 24%) or during infertility or erectile dysfunction evaluation (10 patients, 40%). • Definitive histology reported no malignant histopathological features in all but one patient; this particular patient experienced tumour progression after 2 months and died from advanced disease 1 year later. All other patients are free of disease after a mean follow up of 56 months (range 7–93 months). • During this period one patient developed a second LCT on the contralateral side; another patient had a recurrence within the same testicle, but on the opposite pole. Both underwent a subsequent organ‐sparing tumour resection. CONCLUSION • The percentage of LCT (14.7% of all testicular tumours removed) was significantly higher than expected from the literature. One possible explanation for this phenomenon is the increasing use of better ultrasound technology and the subsequent increased detection of small nodules that have not been found in historical series. Use of ‘observation‐only’ for very small lesions detected at infertility clinics is under debate.

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Section: Introductionmentioning

confidence: 99%

Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques

Leonhartsberger¹,

Ramoner²,

Stoehr³

et al. 2011

BJU International

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“…Furthermore, in recent years it has been recognized that benign lesions represent a significantly higher proportion of testicular masses than previously thought-approaching 50%-most probably owing to the increased use of high resolution ultrasonography that can detect smaller nonpalpable lesions. [5][6][7][8] Radical surgery represents overtreatment of these benign masses.…”

Section: Introductionmentioning

confidence: 99%

Organ-sparing approaches for testicular masses

2010

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Organ-sparing approaches are currently practiced in urology for many malignancies. Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate. Furthermore, many testicular lesions detected clinically or by ultrasonography will be benign, in which case radical orchiectomy represents overtreatment. Partial orchiectomy for benign lesions allows preservation of endocrine and exocrine function, and reduced risk of local recurrence. However, selection criteria are not clear and one must always be suspicious that a GCT might exist. Carcinoma in situ that remains in the salvaged testicle is a challenge to treat. Radiation therapy is an option, although there is a high chance that patients will subsequently require hormonal replacement. Partial orchiectomy should be undertaken only in selected patients--men with bilateral testicular cancer or GCT in a solitary testis--if the size and location of the mass are amenable to surgery. Informed patient consent discussing radical orchiectomy as the gold standard is mandatory, and discussion of the risks associated with CIS and its treatment, as well as the need for androgen supplementation are paramount. Alternative strategies of organ preservation, such as radiotherapy, HIFU and chemotherapy, might be appropriate treatment options in the future. However, the safety and efficacy of these procedures needs to be demonstrated in comparison with partial orchiectomy in larger and prospective studies with longer follow-up.

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“…However, in a prepubertal child, the incidence of benign testicular lesions is high, and associated intratubular germ cell neoplasia is absent and, therefore, testicular-sparing surgery may be considered. 6,9,10 With a conservative procedure, the principles of testicular cancer surgery should be applied. These children should be explored through a high inguinal incision, and a vascular clamp applied to the spermatic cord at the internal inguinal ring.…”

Section: Discussionmentioning

confidence: 99%