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Prevalence and Management of Incidental Testicular Masses-A Systematic Review. J Clin Med 2022; 11:jcm11195770. [PMID: 36233639 PMCID: PMC9573452 DOI: 10.3390/jcm11195770] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/07/2022] [Accepted: 09/27/2022] [Indexed: 11/17/2022] Open
Abstract
Management of incidentally diagnosed small testicular masses (STM) is controversial. Although there is the risk of malignancy, it might be realistic to safely seek preservation of testicles bearing benign masses. This study aims to systematically evaluate the evidence regarding prevalence of STMs, their benign or malignant histology and their management. We conducted a systematic literature search for studies reporting small or incidental testicular masses and their management by radical orchiectomy, testis sparing surgery (TSS) or ultrasound (US) surveillance. We initially screened 2126 abstracts and from these, 57 studies met the inclusion criteria. Testicular masses were detected in 1.74% of patients undergoing US examination. Regarding STMs removed by surgery, 41.12% were benign. Intraoperative frozen section examination (FSE) is a reliable tool to discriminate between benign and malignant testicular masses (average 93.05% accuracy), supporting TSS. Benign lesions were associated with smaller diameter (<1 cm 68.78% benign), were often hypoechoic and exhibited regular margins on US. Conclusions: Small testicular masses are often benign. Clinical and US patterns are not accurate enough for including patients in surveillance protocols and TSS paired with FSE is pivotal for precluding the removal of testicles bearing benign lesions. Future research might unveil new imaging tools or biomarkers to support clinical management.
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Dupeux M, Maxwell F, Rocher L, Izard V, Guettier C, Ferlicot S. Testicular Lesions in Infertile Men. Am J Clin Pathol 2022; 157:936-941. [PMID: 34935941 DOI: 10.1093/ajcp/aqab214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/01/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES An increasing number of incidental testicular tumors are diagnosed in patients during infertility workup. The aim of this study was to evaluate the accuracy of frozen section examination (FSE) for the management of these tumors. METHODS We retrospectively studied a series of 46 testicular tumors diagnosed during exploration for infertility from 2000 to 2019 and submitted for FSE. RESULTS A diagnosis of malignancy was made in 23 cases on both gross examination (yellow-white or cream-colored nodules for seminomas) and FSE, then confirmed on final diagnosis in 22 of the cases. One seminoma reported on FSE was revised as being a Leydig cell tumor. The 23 other lesions were diagnosed as benign on FSE, including 11 Leydig cell tumors (yellow-brown nodules), 2 Leydig cell hyperplasias, and 10 whitish fibrous lesions. All Leydig cell lesions were confirmed except 1, which was reclassified as a Sertoli cell tumor. Of the 10 cases of fibrous lesions, 6 were associated with malignancy. CONCLUSIONS The high incidence of Leydig cell tumors and the accuracy of FSE for these lesions demonstrate the interest in FSE. In contrast, FSE is not reliable for fibrous lesions, and surgeons should be aware that a fibrosis result often corresponds with regressed tumors.
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Affiliation(s)
- Margot Dupeux
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
| | - Florian Maxwell
- Department of Radiology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
| | - Laurence Rocher
- Department of Radiology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris Saclay, Ecole Doctorale Biosigne, ED 419 , Le Kremlin-Bicêtre , France
- Institut Langevin , Paris , France
| | - Vincent Izard
- Department of Urology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
| | - Catherine Guettier
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
| | - Sophie Ferlicot
- Department of Pathology, Assistance Publique–Hôpitaux de Paris, Université Paris-Saclay , Hôpital de Bicêtre, Le Kremlin-Bicêtre , France
- Université Paris-Saclay Faculté de Médecine Paris-Saclay, , Le Kremlin-Bicêtre , France
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3
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Testicular Tumors: A 15-Year Archive Review and Histopathological Evaluation. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.929096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Frozen-section examination in the management of paediatric testicular lesions. Pediatr Surg Int 2021; 37:945-950. [PMID: 33713167 PMCID: PMC8172401 DOI: 10.1007/s00383-021-04870-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2021] [Indexed: 11/02/2022]
Abstract
PURPOSE Paediatric testicular and para-testicular lesions have traditionally been managed according to adult protocols. Testis-sparing surgery (TSS) has gained popularity as it has become apparent benign lesions predominate in childhood. Frozen-section examination (FSE) for intra-operative diagnosis has been extensively utilised in adults, though its use in paediatric practice remains limited. We reviewed our experience of FSE in paediatric patients with an aim to identify the utility and efficacy of this tool in the management of testicular and para-testicular pathology. METHODS A retrospective, single-centre review of paediatric patients who underwent intra-operative FSE for a range of testicular and para-testicular lesions was performed. FSE results were compared to final pathology. TSS was performed if appropriate, and was utilised in adolescent patients, and in lesions with a diameter greater than 20 mm. RESULTS Nine males underwent FSE from 2013 to 2020. Median age at surgery was 9 years (range 1-15). Eight (89%) patients had benign pathology. FSE result correlated with the final pathological examination in 100% of cases. FSE facilitated TSS in 7/9 cases. CONCLUSION FSE has 100% diagnostic accuracy for paediatric testicular and para-testicular pathology. We would recommend all lesions be evaluated by FSE to guide intra-operative decision making and facilitate TSS in appropriate cases.
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Organ-Sparing Surgery in Testicular Tumor: Is This the Right Approach for Lesions ≤ 20 mm? J Clin Med 2020; 9:jcm9092911. [PMID: 32917055 PMCID: PMC7565605 DOI: 10.3390/jcm9092911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 11/25/2022] Open
Abstract
Background: This study was conducted in order to analyze factors predicting malignancy in patients undergoing organ-sparing surgery (OSS) for small testicular lesions. Methods: Patients with small (≤20 mm) marker-negative clinical stage I testicular tumors were managed by OSS with tumor enucleation and frozen section examination (FSE) for the past 15 years at our institution. Benign and malignant cases were compared, focusing on preoperative and postoperative lesion sizes. Results: Eighty-nine patients were enrolled in this retrospective study. Ten (11.2%) of them were treated for synchronous bilateral tumors. Sixty-seven (67.7%) of ninety-nine lesions were benign, confirming a high concordance rate (98%) between FSE and final histology. Patients with benign tumors were significantly older than patients with malignant tumors (p = 0.026), and benign tumors were detected more frequently during urologic work-up of hormone disorders (p = 0.001). Preoperative tumor size was a strong predictor of malignancy (area under the curve (AUC) = 0.726; p < 0.001). According to the Youden index, the best cutoff to predict tumor dignity was 13.5 mm, resulting in a sensitivity and specificity of 53% and 85%, respectively. No cases of local recurrence or distant metastasis were confirmed after a median follow-up of 42 months. Conclusion: Our findings are consistent with previous reports, supporting an OSS approach in small testicular tumors whenever possible. Most tumors ≤ 20 mm were benign, and in the case of malignancy, OSS with FSE and consecutive orchiectomy is oncologically safe due to the high concordance rate of FSE and final histology, thus preventing a two-stage procedure.
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Tullie STE, Quraishi MK, Karawita T, Anjarwalla S. Rare presentation of a testicular glomus tumour. BMJ Case Rep 2019; 12:12/11/e230935. [PMID: 31678923 DOI: 10.1136/bcr-2019-230935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Glomus tumours are atypical in extracutaneous locations and very rarely located in reproductive organs. We present an unusual case of an incidentally discovered glomus tumour arising from the testis of a 47-year-old man. The testicular occurrence of this tumour type is not only exceptionally rare but also serves to highlight the debate regarding the optimal management of incidentally discovered small testicular lesions.
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Affiliation(s)
| | - Mohammed Kamil Quraishi
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Thiwanka Karawita
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Salim Anjarwalla
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
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Vimercati L, Cavone D, Delfino MC, De Maria L, Caputi A, Ferri GM, Serio G. Asbestos exposure and malignant mesothelioma of the tunica vaginalis testis: a systematic review and the experience of the Apulia (southern Italy) mesothelioma register. Environ Health 2019; 18:78. [PMID: 31470859 PMCID: PMC6717382 DOI: 10.1186/s12940-019-0512-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 08/05/2019] [Indexed: 06/02/2023]
Abstract
BACKGROUND Malignant mesothelioma of the tunica vaginalis testis (MMTVT) is a rare disease with a poor prognosis. The diagnosis and management of these lesions are often difficult for pathologists, surgeons, oncologists and occupational physicians. A preoperative diagnosis of malignancy is rarely made, and there is no established effective therapy except orchidectomy. METHODS A systematic literature review was conducted among the articles published in the English literature on primary MMTVT. Moreover four cases from the Apulia mesothelioma register are reported here. RESULTS Two hundred eighty-nine cases of MMTVT have been reported from 1943 to 2018. Overall asbestos exposure has been investigated only for 58% of all cases reported in this review, while in 41.8% this data are not available. Noteworthy is the fact that in many reports there is not an anamnestic reconstruction of any asbestos exposure. A history of direct occupational, environmental or familial asbestos exposure is found in 27.6% of the cases. The four cases from the Apulia mesothelioma register are all with ascertained occupational exposure to asbestos. CONCLUSIONS The true incidence of asbestos exposure in MMTVT is underestimated because of insufficient information reported in older literature. To establish a broad consensus on the causal relationship between asbestos and MMTVT in the scientific community its necessary to analyze the same variables in the epidemiological studies. In general it should be recommended that a positive history of exposure to asbestos or to asbestos-containing materials are at risk for the development of a MMTVT and should be monitored.
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Affiliation(s)
- Luigi Vimercati
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Domenica Cavone
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Maria Celeste Delfino
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Luigi De Maria
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Antonio Caputi
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Giovanni Maria Ferri
- Interdisciplinary Department of Medicine (DIM), Unit of Occupational Medicine, Section Occupational Medicine. “B. Ramazzini”, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
| | - Gabriella Serio
- Department of Emergency and Organ Transplantation (DETO), Pathology Division, University Aldo Moro of Bari Medical School, 11 G. Cesare Square, 70124 Bari, Italy
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Abstract
In any man with a solid testicular mass, cancer should be considered until proven otherwise. Radical inguinal orchiectomy is the treatment of choice in patients with testis mass. Placement of a testicular prosthesis is safe with a very low complication rate and should be offered to all patients undergoing radical orchiectomy. In patients with widespread or life-threatening advanced disease, delayed orchiectomy following chemotherapy is recommended. Testis-sparing surgery can be performed in highly selected patients with solitary testicle mass, bilateral testicular tumors, or strong suspicion of a benign lesion.
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Khan MJ, Bedi N, Rahimi MNC, Kalsi J. Testis sparing surgery for small testicular masses and frozen section assessment. Cent European J Urol 2018; 71:304-309. [PMID: 30386651 PMCID: PMC6202623 DOI: 10.5173/ceju.2018.1695] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Revised: 06/11/2018] [Accepted: 08/06/2018] [Indexed: 11/27/2022] Open
Abstract
Introduction We present our experience with patients who had suspected testicular masses, managed by a frozen section assessment and testicular sparing surgery. Material and methods We 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. Results Twelve 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. Conclusions Our 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.
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Affiliation(s)
- Muhammad Jamal Khan
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital Slough, Berkshire, United Kingdom
| | - Nish Bedi
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital Slough, Berkshire, United Kingdom
| | - Muhammad Naim Che Rahimi
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital Slough, Berkshire, United Kingdom
| | - Jas Kalsi
- Department of Urology, Frimley Health NHS Foundation Trust, Wexham Park Hospital Slough, Berkshire, United Kingdom
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Abstract
Testicular cancer is the most common malignancy among men between 14 and 44 years of age, and its incidence has risen over the past two decades in Western countries. Both genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism is the most common risk factor. Progress has been made in our understanding of the disease since the initial description of carcinoma in situ of the testis in 1972 (now referred to as germ cell neoplasia in situ), which has led to improved treatment options. The combination of surgery and cisplatin-based chemotherapy has resulted in a cure rate of >90% in patients with testicular cancer, although some patients become refractory to chemotherapy or have a late relapse; an improved understanding of the molecular determinants underlying tumour sensitivity and resistance may lead to the development of novel therapies for these patients. This Primer provides an overview of the biology, epidemiology, diagnosis and current treatment guidelines for testicular cancer, with a focus on germ cell tumours. We also outline areas for future research and what to expect in the next decade for testicular cancer.
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Testicular germ cell tumors: revisiting a series in light of the new WHO classification and AJCC staging systems, focusing on challenges for pathologists. Hum Pathol 2018; 82:113-124. [PMID: 30041024 DOI: 10.1016/j.humpath.2018.07.016] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 06/30/2018] [Accepted: 07/14/2018] [Indexed: 11/23/2022]
Abstract
Testicular germ cell tumors (TGCTs) are strikingly heterogeneous, reflecting a complex tumor model, posing serious challenges for pathologists. Accurate classification and staging, according to most recent systems, is fundamental. We aimed to revise a series of consecutively diagnosed TGCTs (2005-2016) in light of the new World Health Organization (WHO) classification and American Joint Committee on Cancer (AJCC) staging systems, discussing dilemmas imposed to pathologists. All 164 patients' clinical files/histological slides were reviewed. Follow-up was last updated on November 2017. Statistical analysis was performed with SPSS (v24). P < 0.05 was considered significant. Non-seminomatous tumors (NSTs) showed more frequently cysts, necrosis, hemorrhage, lymphovascular invasion (LVI) and higher stage than seminomas (SEs) (P < .001, P = .015, P < .001, P = .001, P = .007). Embryonal carcinoma (EC), yolk sac tumor (YST) and teratoma (TE) were the most frequent components in mixed tumors (82.5%, 82.5% and 80.7%). SEs with "atypical features" showed more LVI, higher mitotic count and more extensive necrosis (P = .030, P < .001, P = .016). LVI and >50%EC component, but not rete testis invasion, were associated with higher stage (P < .001, P = .009). Regarding SEs, there was an association between tumor size and both stage (P = .004) and LVI (P < .001). Only four patients disclosed altered stage group when AJCC 8th Edition was employed. Disease recurrence/progression occurred in 5.4% of cases. In two cases, tumor components in metastasectomy specimens were not present in the primary TGCT. Overall survival at 5 years was 98.6%. TGCTs are challenging neoplasms, and pathologists and clinicians alike must be aware of recent updates in classification and staging for adequately tailoring treatment strategies.
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Scandura G, Verrill C, Protheroe A, Joseph J, Ansell W, Sahdev A, Shamash J, Berney DM. Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided? BJU Int 2017; 121:575-582. [DOI: 10.1111/bju.14056] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Glenda Scandura
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - Andrew Protheroe
- Oxford Cancer and Haematology Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Johnson Joseph
- Oxford Cancer and Haematology Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Wendy Ansell
- Department of Medical Oncology; Barts Health NHS Trust; London UK
| | - Anju Sahdev
- Department of Imaging; Barts Health NHS Trust; London UK
| | - Jonathan Shamash
- Department of Medical Oncology; Barts Health NHS Trust; London UK
| | - Daniel M. Berney
- Barts Cancer Institute; Queen Mary University of London; London UK
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Bojanic N, Bumbasirevic U, Bojanic G, Vukovic I, Milojevic B, Pekmezovic T. Testis sparing surgery for treatment of small testicular lesions: Is it feasible even in germ cell tumors? J Surg Oncol 2017; 115:287-290. [DOI: 10.1002/jso.24502] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/21/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Nebojsa Bojanic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | | | | | - Ivan Vukovic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | | | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine; University of Belgrade; Belgrade Serbia
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Matei DV, Vartolomei MD, Renne G, Tringali VML, Russo A, Bianchi R, Cozzi G, Bottero D, Musi G, Mazzarol G, Ferro M, de Cobelli O. Reliability of Frozen Section Examination in a Large Cohort of Testicular Masses: What Did We Learn? Clin Genitourin Cancer 2017; 15:e689-e696. [PMID: 28216275 DOI: 10.1016/j.clgc.2017.01.012] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 01/11/2017] [Accepted: 01/23/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Frozen section examination (FSE) for testicular masses is gaining popularity because of the possibility of performing testis-sparing surgery (TSS) on the basis of the FSE results. The aim of our study was to investigate the reliability of FSE in the diagnosis of testicular masses. PATIENTS AND METHODS From 1999 to 2016, 144 of 692 patients who underwent surgery in our tertiary center for testicular masses had FSE. The indications for FSE were: masses < 1 cm, nonpalpable, multiple, or with unusual presentation. Mean follow-up for patients was 25.5 months. The algorithm of surgery determined by FSE was: orchiectomy if malignant or nonconclusive pathology; TSS if benign or nontumor pathology. FSE data were analyzed retrospectively. Specificity and sensitivity of the method was calculated for benign, malignant, seminoma, and nonseminoma tumors. RESULTS Intraoperative FSE was conducted on 21% of candidates for surgery on testicular masses. The sensitivity and specificity of FSE were 93% and 98%, respectively, for malignant tumors, and 90% and 99%, respectively, for benign tumors. The κ agreement coefficient between FSE and final histopathology was statistically significant (0.76). TSS was performed in 57 (40%) patients, including 6 of 23 monorchid patients. CONCLUSION FSE correlates well with final histopathological diagnosis of testicular masses. Thus, it reliably identifies patients who might benefit from TSS. FSE should be considered always in small, nonpalpable, multiple, or uncommonly presenting masses in solitary testis or both testes.
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Affiliation(s)
| | - Mihai Dorin Vartolomei
- Division of Urology, European Institute of Oncology, Milan, Italy; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Targu Mures, Romania
| | - Giuseppe Renne
- Department of Laboratory and Pathology, European Institute of Oncology, Milan, Italy
| | | | - Andrea Russo
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Roberto Bianchi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Gabriele Cozzi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Danilo Bottero
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Division of Urology, European Institute of Oncology, Milan, Italy
| | - Giovanni Mazzarol
- Department of Laboratory and Pathology, European Institute of Oncology, Milan, Italy
| | - Matteo Ferro
- Division of Urology, European Institute of Oncology, Milan, Italy.
| | - Ottavio de Cobelli
- Division of Urology, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy
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16
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Miyamoto H. Clinical benefits of frozen section assessment during urological surgery: Does it contribute to improving surgical margin status and patient outcomes as previously thought? Int J Urol 2016; 24:25-31. [PMID: 27862367 DOI: 10.1111/iju.13247] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/05/2016] [Indexed: 12/18/2022]
Abstract
Despite significant advances in patient selection as well as surgical technique over the past few decades, it is still not uncommon for patients with urological malignancy and positive surgical margins to be observed. Meanwhile, intraoperative pathology consultation with frozen section assessment, which generally provides useful information for the optimal procedure, has been widely utilized for the assessment of surgical margins during urological surgeries. Thus, it remains unanswered whether intraoperative frozen section assessment has an impact on final surgical margin status as well as long-term oncological outcomes. The present review summarizes and discusses available data assessing the utility of frozen section assessment of the surgical margins during urological surgeries, such as radical prostatectomy, partial nephrectomy and radical cystectomy. The current findings suggest that select patients might benefit from the routine frozen section assessment.
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Affiliation(s)
- Hiroshi Miyamoto
- Departments of Pathology and Urology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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17
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Zhang XF, Long ZD, Liu XM, Ma F, Li Q, Lv Y. Na(+) Micro-Current Value Detection as a New Modality for Identification of Benign and Malignant Disease in Surgery. Sci Rep 2016; 6:24937. [PMID: 27103487 PMCID: PMC4840309 DOI: 10.1038/srep24937] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 04/07/2016] [Indexed: 02/04/2023] Open
Abstract
Increase of intracellular positive ions (mainly Na(+)) indicates greater possibility of cell malignancy. The present study investigated the correlation between the Na(+) micro-current value (MCV) and tissue characteristics (normal, benign or malignant). 346 tissue samples have been detected within 30 min after surgical isolation by Na(+) detector. MCV in 102 malignant tumor was significantly higher than that in benign/borderline tumor or normal tissue (33.3 ± 8.9 μA vs. 24.4 ± 8.6 μA and 14.0 ± 4.0 μA, p < 0.001, respectively). MCV in malignant tumor parenchyma was significantly higher than that in the paired paracanceroustissue, normal tissue and surgical margin tissue (33.3 ± 8.9 μA vs. 18.9 ± 4.1, 14.2 ± 4.0 or 15.2 ± 3.3, p < 0.001, respectively). However, the coincidence rate between Na(+) detector and pathological examination was different in tissues from different organs or systems, which was high in pancreas, bile duct system, gastrointestinal system, esophagus, breasts, lungs, nose &throat and thyroids, but poor in urinary tissue. The overall coincidence rate was 83.1% (108/130) between Na(+) detector and pathological examination. The sensitivity and specificity of correct diagnosis by Na(+) detector was 83.3% (70/84) and 82.6% (38/46), respectively. This new modality may have diagnostic potential in complementing frozen examination in differentiating malignant tumor from benign or normal tissue, justifying tumor metastatic scope and confirming surgical margin.
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Affiliation(s)
- Xu-Feng Zhang
- Department of Hepatobiliary Surgery, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center. Xi'an 710061, China
| | - Zhi-Da Long
- Department of Hepatobiliary Surgery, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center. Xi'an 710061, China.,Jingzhou Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jingzhou 434020, China
| | - Xue-Min Liu
- Department of Hepatobiliary Surgery, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center. Xi'an 710061, China
| | - Feng Ma
- Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center. Xi'an 710061, China
| | - Qiang Li
- Jiangsu Kunshan Bokang Medical Technology Co. Ltd., Kunshan 215300,China
| | - Yi Lv
- Department of Hepatobiliary Surgery, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Institute of Advanced Surgical Technology and Engineering, the First Affiliated Hospital Xi'an Jiaotong University, Xi'an 710061, China.,Shaanxi Provincial Regenerative Medicine and Surgical Engineering Research Center. Xi'an 710061, China
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Ahmed Z, Singh S, Mangal A, Mittal A. Primary malignant mesothelioma of the spermatic cord. BMJ Case Rep 2016; 2016:bcr-2016-214602. [PMID: 27045050 DOI: 10.1136/bcr-2016-214602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Primary spermatic cord malignant mesothelioma is an extremely rare tumour with only 12 cases reported so far. It is an aggressive tumour with a high recurrence rate. A 45-year-old man presented with a slow growing right inguinal swelling for the past 1 year. Physical examination revealed a well-circumscribed, hard, non-reducible swelling palpable along the medial extent of the inguinal canal with no cough impulse. Fine-needle aspiration cytology suggested metastatic carcinoma. Contrast-enhanced CT of the thorax and abdomen did not reveal any primary. Right high inguinal orchidectomy was performed at another institution. Postoperative histopathological examination (HPE) and immunohistochemistry suggested biphasic malignant mesothelioma with resected margin positive. The patient was referred to us for revision surgery and adjuvant therapy. Postoperative course was uneventful. Currently, he is undergoing radiotherapy.Surgery is the first-line treatment. Patients should receive adjuvant radiotherapy and/or chemotherapy and long-term follow-up surveillance.
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Affiliation(s)
- Zeeshan Ahmed
- Division of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Suresh Singh
- Division of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Akshay Mangal
- Division of Surgical Oncology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
| | - Alka Mittal
- Department of Pathology, SMS Medical College and Hospital, Jaipur, Rajasthan, India
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