Management of incidental impalpable intratesticular masses of ≤ 5 mm in diameter

Müller, T; Gozzi, Christian; Akkad, Thomas; Pallwein, Leo; Bartsch, Georg; Steiner, Hannes

doi:10.1111/j.1464-410x.2006.06485.x

Cited by 65 publications

(43 citation statements)

References 22 publications

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“…In case of lesions less than 5 mm (4/8), we founded a seminoma in two case (50%) and a benign Leydig cell tumor in one case (25%). Muller et al (11) reported a series of 20 men diagnosed with a tumor mean diameter of 3.5 mm with four patients (20%) who underwent an IRO because the lesions were found to be malignant. In all case, the resected specimen revealed a multifocal TIN.…”

Section: Discussionmentioning

confidence: 99%

Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience

Fabiani

Filosa

Fioretti

et al. 2014

Arch Ital Urol Androl

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Introduction and objectives:The widespread use of scrotal ultrasound (SUS) has led to a marked increase in the number of incidentally detected testicular lesions. A small incidental nodule (STN) has defined as a non palpable (< 10 mm), asymptomatic solid lesion with normal levels of oncological testicular markers. Nowadays the lack of agreement on the topic causes managing problems to andrologists. We present our experience consisting in 8 cases of STN discovered by SUS performed for different clinical indications. Matherial and methods: We retrieved from our ultrasonographic files the clinical information about 717 patients evaluated for andrological problems. Patients with STN underwent to a complete clinical history and physical examination as well as oncological testicular markers measurement and ormonal assessment and then received a diagnostic ultrasound guided excisional biopsy (DEB). Surgical approach was performed through an inguinal incision. Using the coordinates previously obtained from preoperative SUS, STN was localized by intraoperative SUS. The lesion was enucleated and sent to the Pathology department for frozen section examination (FSE). Biopsies of affected testis (TB) were also performed. Post-excision ultrasound has been used to confirm the complete removal of the nodule. Whether pathological findings were benign, testis sparing surgery (TSS) was performed. Immediate radical orchidectomy (IRO) was performed if FSE and TB findings suggested a malignant lesion. Results: STNs were discovered in 8 patients (1,1%). Very small lesions (< 5 mm) were detected in 50% of cases. We performed four IRO and four DEB with consequent TSS. In one case we performed a delayed radical orchidectomy (DRO). At FSE pathologist reported 3 Leydig cell tumor and 3 seminoma and an inflammatory regressive lesion in one case. FSE on TB reported intratesticular neoplasia (TIN) in three cases. In one case nodule wasn't sent to FSE. We observed a concordance between FSE and definitive pathologic report in six cases (75%). SummaryNo conflict of interest declared.

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Section: Discussionmentioning

confidence: 99%

Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience

Fabiani

Filosa

Fioretti

et al. 2014

Arch Ital Urol Androl

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“…Although several case series have reported on the malignant risk of small, incidentally-detected testicular masses, results have been contradictory [5][6][7][8][9][10][11][12][13][14]. We report our experience in a contemporary series of patients who underwent radical orchidectomy for non-palpable testicular masses and comment on their malignant potential.…”

Section: Introductionmentioning

confidence: 92%

Nonpalpable Testicular Masses—Should We Be Worried?

Abboudi¹,

Malde²,

Mchaourab³

et al. 2013

OJU

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Objective: To report our experience of a contemporary series of patients who underwent radical orchidectomy for non-palpable testicular masses, in order to comment on their malignant potential and identify any factors predictive of a malignant outcome. Materials and Methods: We reviewed the case-notes of patients who underwent radical inguinal orchidectomy over a 22-month period between January 2010 and October 2011. Results: A total of 71 patients were analysed, with a mean (range) age of 45 years (17 -82). Overall, 41 (57.7%) orchidectomies were malignant and 30 (42.3%) were benign. There were 20 (28%) non-palpable testicular masses found incidentally on ultrasound, and of these 40% were malignant and 60% were benign. In total 6 of these non-palpable lesions were <1 cm in size, and of these 66.6% were malignant and 33.3% were benign. The majority of tumours were in patients under the age of 50, but there was no correlation between the lesion size and the risk of a malignant outcome. Conclusion: In view of the significant rate of malignancy in non-palpable testicular masses we recommend surgical intervention over surveillance alone. However, as the majority of these lesions may eventually turn out to be benign, we suggest that testis-sparing surgery is the optimal approach, and should be performed in centres where the required radiological, histopathological, and surgical expertise exists.

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“…An obvious disadvantage is the investigatordependence, with sometimes poor documentation [6]. Nevertheless, SUS is highly sensitive for detecting testicular tumours, but with the disadvantage of low specificity [3]. Because of this, surgical exploration is indicated if an intratesticular lesion has been detected by SUS, even if there is no clear suspicion of malignancy [7].…”

Section: Discussionmentioning

confidence: 99%

Routine scrotal ultrasonography during the follow‐up of patients with testicular cancer leads to earlier detection of asynchronous tumours and a high rate of organ preservation

et al. 2010

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Study Type – Diagnosis (case series) Level of Evidence 4OBJECTIVETo compare outcomes of patients with asynchronous tumours detected before and after the introduction of scrotal ultrasonography (SUS) during routine follow‐up examinations.PATIENTS AND METHODSSince January 2001 SUS was also used during the follow‐up of patients with testicular cancer. A series of 16 consecutive patients with asynchronous bilateral testicular tumours diagnosed while still complying with routine follow up investigations were identified and divided into two groups; group A was diagnosed by palpation only, before 2001, and group B was diagnosed after 2000. The groups were compared statistically for the interval between asynchronous tumours, clinical stage, tumour diameter at the time of diagnosis and rate of testis‐sparing surgery.RESULTSAll tumours in group A were diagnosed by palpation, but only two in group B were palpable at the time of diagnosis. The mean tumour diameter was statistically significantly smaller in group B (1.2 cm) than in group A (2.68 cm); testis‐sparing surgery was used in all of group B and only three patients in group A. After organ‐sparing surgery all patients had normal testosterone levels. All patients after organ‐sparing surgery had adjuvant scrotal radiotherapy because of germ cell tumour, and no patient had a local recurrence.CONCLUSIONOur data indicate that using SUS for the remaining testicle in routine follow‐up visits of patients with testicular cancer leads to the earlier detection of smaller tumours and, consequently, a higher rate of organ preservation. The maintenance of physiological endocrine function might finally result in a better quality of life.

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Management of incidental impalpable intratesticular masses of ≤ 5 mm in diameter

Cited by 65 publications

References 22 publications

Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience

Diagnostic ultrasound-guided excisional testicular biopsy for small (< 1 cm) incidental nodules. A single institution experience

Nonpalpable Testicular Masses—Should We Be Worried?

Routine scrotal ultrasonography during the follow‐up of patients with testicular cancer leads to earlier detection of asynchronous tumours and a high rate of organ preservation

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