Impalpable testis cancer

Hindley, Richard G.; Chandra, Ashish; Saunders, Andrew; O'Brien, Timothy

doi:10.1046/j.1464-410x.2003.04432.x

Cited by 28 publications

(24 citation statements)

References 9 publications

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“…Although US can identify these lesions, it is not always possible to use imaging to determine whether they are reactive or neoplastic and benign or malignant [8,9]. The benefits of testicle-sparing surgery include the improvement of the patient's overall quality of life, fertility and endocrine function, and the avoidance of the negative cosmetic effects of radical orchiectomy [10]. Hopps et al [11], who performed intraoperative US-guided localization and the subsequent surgical excision of small testicular tumours, proposed surgical exploration for non-palpable, hypoechoic testicular masses.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses

Dell’Atti¹

2015

J Ultrasound

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Purpose The aim of the present study was to evaluate evolution of conservative echo-guided surgery for testicular tumours B1.5 cm and to assess the safety of this surgical procedure. Methods 49 consecutive patients diagnosed with ultrasonography testicular lesions (mono or bilateral) B1.5 cm and treated with conservative echo-guided testicular surgery were examined. The parameters considered in this retrospective analysis included case history, physical examination, scrotal and abdominal ultrasonography, computed tomography scan, size of the nodule (maximum diameter), tumour markers, chest radiography, frozen section examination, histologic size of the tumour, overall survival (OS) and findings on follow-up. Results Mean age of patients was 33 years (range 18-62). Patients who presented with a palpable testicular nodule were 32.7 %, gynecomastia 10.2 %, precocious pseudopuberty 4 %, and scrotal pain 12.2 %. Permanent section examination confirmed the FSE data in all cases of certainty malignant lesion and definitive histological types were: 22 seminoma, 13 non-seminomatous or mixed germ cell tumours, 4 Leydig tumours, 2 hamartoma, 1 epidermoid cyst, 2 sertoli cell tumours, and 5 fibrous pseudotumour. No complications intra-and postoperative were observed. Overall survival was 100 % and scrotal US showed evidence of local tumour recurrence in 6 patients (12.2 %) after a mean follow-up of 34.7 months. ConclusionThe OS, the low rate of local recurrence, and absence of complications, tend to demonstrate the safety of the procedure. The benefits to testicular-sparing surgery include improving the patient's overall quality of life, fertility, endocrine function and negative cosmetic effects of radical orchiectomy.Keywords Testicular tumour Á Ultrasound Á Testiclesparing surgery Á Small testicular mass Á Non-palpable Riassunto Scopo del lavoro Lo scopo del presente studio è stato quello di valutare il ruolo della terapia chirurgia ecoguidata conservativa nel trattamento dei tumori testicolari B1.5 cm e valutarne la sicurezza ed efficacia. Metodi Furono esaminati 49 pazienti con diagnosi ecografica di lesione testicolare (mono o bilaterale) B1.5 cm e sottoposti a chirurgia testicolare conservativa ecoguidata. I parametri presi in considerazione in questo studio retrospettivo furono la storia clinica del paziente, l'esame obiettivo, l'ecografia scrotale ed addominale, la TAC, le dimensioni della lesione, i marcatori tumorali, la radiografia del torace, l'esame istologico estemporaneo e definitivo della lesione, il tasso di sopravvivenza globale e i risultati del follow-up. Risultati L'età media dei pazienti è stata di 33 anni (range 18-62). Il 32.7 % dei pazienti presentavano un nodulo testicolare apprezzabile palpatoriamente, il 10.2 % ginecomastia, il 4 % pseudopubertà precoce, mentre il 12.2 % dolore scrotale. In tutti i casi l'esame istologico definitivo delle lesioni tumorali aveva confermato i risultati riscontrati all'esame istologico estemporaneo. Gli istotipi definitivi furono: 22 tumori seminomatosi, 13...

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Section: Discussionmentioning

confidence: 99%

Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses

Dell’Atti¹

2015

J Ultrasound

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“…Comiter et al [9] found a high rate of malignant pathology (73%) amongst non-palpable testicular masses, although this study included patients with retroperitoneal or neck masses in whom testicular ultrasound was performed in order to identify a potential primary tumour, and therefore this higher rate of malignancy would be expected. Hindley et al [18] reported 3 out of 4 non-palpable lesions to be seminomatous, whilst Avci et al [14] reported 8 out of 9 non-palpable masses to be malignant.…”

Section: Discussionmentioning

confidence: 99%

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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“…Ultrasound can detect lesions in the testis itself. Hypoechoic lesions of the testis frequently indicate the presence of malignancy (9). Some of these tumors may not be palpable.…”

Section: Treatment and Managementmentioning

confidence: 99%

Metachronous Testicular Seminoma-16 Years Later: Early Detection and Management /Case Report/

Veltchev¹

2010

JofIMAB

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ABSTRACT:A 28-year-old male presented at a regional hospital with a pulling sensation and feeling of unusual heaviness in the right scrotum. Pain and discomfort appeared two weeks ago.The patient had no previous medical history. Physical examination, US and CT confirmed 26 mm mass, localized centrally in the right testis without metastatic process and patient was treated with right inguinal orchiectomy, followed by 25 Gy radiotherapy. After 16 years and 3 months the same symptomatology started in the left side and US discovered two masses: 15 and 21 mm in left testis. Investigation included tumor marker assessment, scrotal US, CT and biopsy. Diagnosis metachronous testicular seminoma, stage T1N1M0.Biopsy, radical orchiectomy, androgen substitution and follow-up were performed.Key words: seminoma, bilateral, metachronous, germcell tumor. THE CASE:A 28-year-old male presented at a regional hospital with a sensation and feeling of unusual heaviness in the right scrotum. Pain and discomfort appeared two weeks ago. The patient had no previous medical history. US imaging showed a right side mass, measuring 28x20 mm and normal left testis. A CT scan revealed no evidence of infiltration of spermatic cord or the inguinal and paraaortic lymph nodes. Blood serum tumor markers of human chorionicgonadotropin (HCG), á-fetoprotein (AFP), and lactate dehydrogenase (LDH) were in referent levels. After consultation with anesthesiologist, right inguinal height orchectomy was made. Histology demonstrated a seminoma, without infiltrating tunica albuginea-stage pT1N0M0 tumor according UICC (Union International Against Cancer).One month after operation, the patient was presented to the hospital multidisciplinary oncology group and started radiotherapy in dose of 25Gy to the periaortic lymph nodes. Patient was accepted as disease free and according the protocol was followed up every 4 months the first two years with chest X-ray, CT, physical examination and tumor marker assessment.In May 2009, 16 years and 3 months after the first orchectomy, the patient complained in a medical office of enlarged left testis, firm in consistency and with a sensation for heaviness. Scrotal ultrasonography revealed two hypoechoic left-testicular masses measuring 19x12 mm and 13x7 mm (Fig. 1).Patient was referred to a specialized urologic clinic, where repeated physical and imaging study revealed no evidence of metastases, and serum concentrations of testosterone, â-HCG, LDH, and AFP were all within normal ranges. No suspicions for spread on CT of chest and abdomen.In elective plan left inguinal exploration and frozen section biopsy with confirmation of germ cell tumor-pure seminoma was made (Fig. 2).The tumors measured 12 mm and 10 cm in greatest dimension, respectively, and were confined to the testis. One lymph node was detected 2 cm in the spermatic cord but negative for neoplastic invasion. Second pT1N0M0 was found. Daily topical testosterone replacement therapy was administered, beginning on the first postoperative day-in the form of a hydroalcoholi...

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Impalpable testis cancer

Cited by 28 publications

References 9 publications

Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses

Efficacy of ultrasound-guided testicle-sparing surgery for small testicular masses

Nonpalpable Testicular Masses—Should We Be Worried?

Metachronous Testicular Seminoma-16 Years Later: Early Detection and Management /Case Report/

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