Testicular lesions other than germ cell tumours: feasibility of testis‐sparing surgery

Abstract

OBJECTIVETo review all non‐germ‐cell testicular lesions presenting at our institution and to determine the feasibility of testis‐sparing surgery for these patients.PATIENTS AND METHODSAll surgery for testicular masses between June 1995 and June 2005 were reviewed retrospectively. Patients with atrophy, germ cell tumours, infection or torsion were excluded. The study comprised men who had radical orchidectomy for suspected germ‐cell tumour but had other final pathology, and those where testis‐sparing surgery was attempted for a presumed benign lesion.RESULTSThirteen patients with lesions appropriate for the study were identified; all but one had a palpable lesion. The lesions could be categorized as inflammatory (three hyalinized fibrosis, two sarcoidosis, one chronic inflammation), cystic (one epidermoid cyst, one unilocular cyst), benign neoplasms (two adenomatoid tumours, one Leydig cell tumour, one capillary haemangioma) or malignant neoplasms (one lymphoma). Based on the preoperative impression, testis‐sparing surgery was attempted in eight of the lesions and was successful in six where it was attempted. In the other five, testis‐sparing surgery was not attempted because the preoperative impression was that of a germ cell tumour. Testis‐sparing surgery was successful in only six of the 13 patients with these lesions.CONCLUSIONTestis‐sparing surgery might be possible if there is significant suspicion of a benign lesion. If frozen‐section analysis is equivocal, a radical orchidectomy is required. Testis‐sparing surgery was feasible in highly selected cases.

Systemic sarcoidosis mimicking advanced testicular cancer

“…An inguinal approach open biopsy with intra-operative clamping of the spermatic cord allows intra-operative frozen sections for histological examination (and potential testicle preservation) but can progress to radical orchidectomy if biopsy is equivocal or suggests malignancy. 12 Other centres advocate radical orchidectomy whenever there is a potential diagnosis of testicular malignancy to prevent diagnostic delays or errors. 13 Corticosteroids are indicated in GUS as they can reduce testicular pain and improve associated azoospermia.…”

Contemporary diagnostic work-up of testicular germ cell tumours

“…109 If FSE reveals a benign lesion, all layers are closed and the testis is returned to the scrotum. 112 In case of malignancy, the testis is only preserved in solitary gonads. If multifocality of GCT is ruled out, 113 adjuvant r adiotherapy is required to treat TIN in the remaining testis.…”

Testis-sparing surgery for a post-pubertal testicular dermoid cyst: A case report and literature review

“…In recent years, testicular-sparing surgery has been successfully performed in cases where the preoperative likelihood of benign disease was high. 8,9 In patients with small, malignant germ cell tumors, testicular-sparing surgery coupled with local adjuvant therapy showed good oncologic control in most cases. 10 An intraoperative frozen-section examination can accurately diagnose testicular cancer, 9 and radical orchiectomy should be performed if an equivocal lesion is found.…”