Nonpalpable Testicular Masses—Should We Be Worried?

Abstract

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.

The Diagnostic Value of the Added MR Imaging of the Scrotum in the Preoperative Workup of Sonographically Indeterminate Testicular Lesions—A Retrospective Multicenter Analysis

“…At primary diagnosis, malignant testicular tumors have a median size of 3 cm (IQR 1.8–4.5 cm) [ 27 ]. Abboudi et al also showed in 2013 that over two-thirds of testicular tumors < 1 cm were benign [ 28 ].…”

Radiological features characterising indeterminate testes masses: a systematic review and meta‐analysis

“…In the presence of a normal contralateral testis, inguinal RO is the standard of care for all males diagnosed with a testicular mass suspicious for malignancy or an indeterminate testicular mass, despite a significant risk of over treatment [7,8]. However, this must be balanced with the risks of under treatment (e.g., surveillance with the potential effects of delayed treatment on survival and the psychological burden of disease surveillance).…”

“…However, RO can negatively impact fertility, endocrine function, sexual satisfaction as well as leading to anxiety and depression [5]. This is important as ~30% of ROs for impalpable testicular masses in post‐pubertal males and between 63%–94% in pre‐pubertal males are histopathologically benign [6–8]. The increasing application and widespread use of SUS and the limitations of SUS and scrotal MRI in their ability to accurately identify a testicular mass as either benign or malignant, represents a significant management dilemma for clinicians, particularly in the context of an indeterminate testicular mass [9].…”