Testis Sparing Surgery For Small Testicular Masses and Frozen Section Assessment

Abstract

IntroductionWe present our experience with patients who had suspected testicular masses, managed by a frozen section assessment and testicular sparing surgery.Material and methodsWe performed a retrospective review of all patients over the last 5 years, who underwent a frozen section assessment and testicular sparing surgery for small testicular lesions. The frozen section assessment was compared with the final histology.ResultsTwelve patients were identified. The mean age of patients was 40 years (22–58 years). The mean lesion size was 9.8 mm (3–18 mm). Presentations varied: a testicular lump was palpable in 7 patients and 3 patients were referred due to infertility with a subsequent ultrasound, which showed incidental testicular lesions. Two patients presented with testicular pain. Tumour marker levels were within the normal limits in all patients.The frozen section assessment correctly determined 10 out of 12 (83%) lesions, showing 1 (8%) lymphoma, 2 (17%) seminomas, 3 (25%) fibrosis, 3 (25%) low-grade Leydig cell tumours and 1 (8%) adenomatous tumour. The frozen section reported a benign epidermal cyst in 1 case, whilst the final histology showed a pre-pubertal type teratoma, a rare and low risk tumour. One patient (8%) had an indeterminate lesion, which proved to be a benign adenomatous tumour on final histology. All malignant cases were correctly identified.There was no malignancy in 9 out of 12 (75%) patients therefore they had testicular sparing surgery. Three patients had orchidectomy, two due to a seminoma and one due to an indeterminate lesion. One patient developed a postoperative haematoma requiring antibiotics but there were no other complications.ConclusionsOur findings demonstrate that partial orchidectomy with a frozen section assessment is useful in small testicular masses and testicular sparing surgery can be considered in order to prevent a radical orchidectomy in selected patients.

Prevalence and Management of Incidental Testicular Masses—A Systematic Review

“…Our results showed that FSE is highly reliable for detecting malignant lesions throughout the reported case series, reaching 100% accuracy in 25 out of 38 studies (66%) [ 8 , 10 , 12 , 13 , 14 , 15 , 16 , 17 , 22 , 25 , 26 , 29 , 31 , 34 , 35 , 40 , 42 , 43 , 46 , 48 , 51 , 53 , 55 , 57 , 58 ]. Good accuracy was also reported in five studies, namely, by Connolly and colleagues (96.1%) [ 49 ], in the 14 years of experience reported by Silverio et al (96%) [ 56 ], by Matei et al (93%) [ 54 ], in an earlier study by Dell’Atti (84.3%) [ 50 ] and by Ferretti et al (83.33%) [ 52 ].…”

“…Ultimately, 57 studies were included in the final list. Thirty-nine of them described cases of impalpable testicular masses diagnosed incidentally by US [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 ], and 47 included information about the histology of small testicular masses that underwent surgical treatment [ 5 , 6 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 24 , 25 , 26 , 28 , 29 , 30 , 31 ,…”

“…These results clearly support the use of FSE to decide on a conservative or radical surgical approach for STMs. All patients must be aware that they may need a radical orchidectomy if frozen section assessment is positive for cancer or deemed inconclusive or inaccurate [ 31 ]. Therefore, close collaboration between the pathologist and the urologic surgeon is required when testis sparing surgery is contemplated [ 42 ].…”