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Saltzman AF, Hensley P, Ross J, Woo L, Billmire D, Rescorla F, Puri D, Patel S, Pierorazio P, Bagrodia A, Cary C, Cost NG. Critical elements of pediatric testicular germ cell tumors surgery. Semin Pediatr Surg 2023; 32:151343. [PMID: 38006835 DOI: 10.1016/j.sempedsurg.2023.151343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2023]
Abstract
Children, adolescents and young adults with testicular germ cell tumors require appropriate surgical care to insure excellent outcomes. This article presents the most critical elements, and their basis in evidence, for surgery in this population. Specifically, the importance of inguinal radical orchiectomy for malignant tumors, partial orchiectomy for prepubertal tumors and normal serum tumor markers, and the appropriate use of post-chemotherapy retroperitoneal lymph node dissection in those with residual retroperitoneal masses.
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Affiliation(s)
| | - Patrick Hensley
- Department of Urology, University of Kentucky, Lexington, KY, USA
| | - Jonathan Ross
- Department of Urology, Rush University, Chicago, IL, USA
| | - Lynn Woo
- Department of Urology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Deborah Billmire
- Department of Pediatric Surgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Frederick Rescorla
- Department of Pediatric Surgery, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, IN, USA
| | - Dhruv Puri
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Sunil Patel
- Department of Urology, The James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Aditya Bagrodia
- Department of Urology, University of California San Diego, La Jolla, CA, USA
| | - Clint Cary
- Department of Urology, Indiana University, Indianapolis, IN, USA
| | - Nicholas G Cost
- Division of Urology, Department of Surgery at the University of Colorado School of Medicine, Aurora, CO, USA; The Surgical Oncology Program, Children's Hospital Colorado, Aurora, CO, USA.
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Nishio H, Mizuno K, Kato T, Kamisawa H, Kurokawa S, Nakane A, Maruyama T, Kawai N, Yasui T, Hayashi Y. Surgical management of prepubertal testicular tumors: A 30-year study in our institution. Int J Urol 2023; 30:521-525. [PMID: 36861413 DOI: 10.1111/iju.15168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 01/29/2023] [Indexed: 03/03/2023]
Abstract
OBJECTIVES The 2021 European Association of Urology-European Society for Paediatric Urology guidelines on Pediatric Urology recommended testis-sparing surgery (TSS) as the primary approach to treat prepubertal testicular tumors exhibiting favorable preoperative ultrasound diagnoses. However, prepubertal testicular tumors are rare and clinical data regarding them is limited. Here, we analyzed the surgical management of prepubertal testicular tumors based on cases observed over approximately 30 years. METHODS Data were retrospectively reviewed from medical records of consecutive patients aged <14 years with testicular tumors who received treatment at our institution between 1987 and 2020. We compared patients by their clinical characteristics, namely, those who underwent TSS versus radical orchiectomy (RO) and those who received surgery in 2005 onward versus prior to 2005. RESULTS We identified 17 patients, with a median age at surgery of 3.2 years (range 0.6-14.0) and a median tumor size of 15 mm (range 6-67). The tumor size was significantly smaller in patients who underwent TSS than in those who underwent RO (p = 0.007). Patients treated in 2005 onward were more likely to undergo TSS than those treated prior to 2005 (71% vs. 10%, respectively), without significant differences in tumor size or the rate of preoperative ultrasound. No TSS cases required conversion to RO. CONCLUSIONS Recent improvements in ultrasound imaging technology allow for more accurate clinical diagnosis. Therefore, the indications of TSS for prepubertal testicular tumors can be judged based not only on the tumor size but also on the diagnosis of benign tumors by preoperative ultrasound.
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Affiliation(s)
- Hidenori Nishio
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kentaro Mizuno
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Taiki Kato
- Department of Urology, Nagoya City University East Medical Center, Nagoya, Japan
| | | | | | - Akihiro Nakane
- Department of Urology, Gamagori City Hospital, Gamagori, Aichi, Japan
| | - Tetsuji Maruyama
- Department of Urology, Nagoya City University East Medical Center, Nagoya, Japan
| | - Noriyasu Kawai
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Takahiro Yasui
- Department of Nephro-urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yutaro Hayashi
- Department of Pediatric Urology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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3
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Sugawara E, Sato T, Katsumata K. Dr. Sugawara et al reply. J Rheumatol 2023; 50:715. [PMID: 36319010 DOI: 10.3899/jrheum.220923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Eri Sugawara
- Department of Rheumatology, Tonan Hospital, Sapporo, Japan.
| | - Taiki Sato
- Department of Rheumatology, Tonan Hospital, Sapporo, Japan
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Benabdallah W, Loghmari A, Othmane MB, Ouahchi I, Hmida W, Jaidane M. Left paratesticular fibrous pseudotumor on the single testis and contribution of imaging in therapeutic management, a case report. Int J Surg Case Rep 2023; 105:108077. [PMID: 36996707 PMCID: PMC10070615 DOI: 10.1016/j.ijscr.2023.108077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/08/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Paratesticular fibrous pseudotumor is a rare benign tumor. Clinically, it can mimic testicular malignancy, but this lesion results from a reactive proliferation of inflammatory and fibrous tissue. CASE PRESENTATION A 62-year-old man presented with left scrotal swelling dating back years. A left paratesticular mass is palpated, firm and painless. Ultrasound showed a heterogeneous and hypoechoic lesion in a single left testicle; the right testicle was not found in the scrotum or at the inguinal level. CT scan showed a hypodense left scrotal mass. The scrotal MRI showed the presence of a paraliquid left intrascrotal formation pushing back the left testicle. We performed a scrotal exploration with excision of the paratesticular mass, sparing the left testicle. The definitive pathological diagnosis was reported as paratesticular fibrous pseudotumor. CLINICAL DISCUSSION Paratesticular Fibrous pseudotumors are a rare tumor with approximately 200 cases reported to date. These lesions constitute 6 % of all paratesticular lesions. Magnetic resonance imaging can give additional information when an ultrasound is inconclusive. The treatment of choice is a scrotal exploration of the mass and frozen section biopsy to avoid unnecessary orchiectomy. CONCLUSION The diagnosis of paratesticular Fibrous pseudotumor is challenging. The contribution of scrotal MRI and intra-operative frozen section is essential for therapeutic management.
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Schexnayder KS, Ortiz-Hernandez V, Nordin NJ, Giel DW. Chlamydia Trachomatis Masquerading as Scrotal Masses in Adolescents. Urology 2023; 171:196-200. [PMID: 35998862 DOI: 10.1016/j.urology.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 08/03/2022] [Accepted: 08/08/2022] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To present a case series of 3 post-pubertal adolescent males with Chlamydia trachomatis presenting as scrotal masses. Scrotal masses are worrisome for malignancy, especially when imaging confirms intratesticular lesions. However, there are benign conditions which may mimic testicular cancer. Some of these conditions may not be readily considered in the pediatric population. This phenomenon is rare in the pediatric population, and this represents only the second report in the literature of this finding. METHODS Three cases of adolescent males who presented with a scrotal mass were reviewed. Traditional work up was performed, and results are reviewed. RESULTS Median age for these patients was 16 years (range 16-17). All patients underwent scrotal ultrasound confirming intratesticular lesions. Two of the 3 patients denied sexual activity within the past year. Two patients underwent orchiectomy after counseling and shared decision making, with both specimens demonstrating no malignancy. All 3 patients were eventually diagnosed with Chlamydia trachomatis and treated with appropriate antibiotic therapy. CONCLUSION Adolescent males who are sexually active can present with Chlamydia trachomatis infection masquerading as a scrotal mass. It is important to consider infectious etiologies in this patient group as it has been documented that many adolescents are hesitant to admit to sexual activity. Thus, routine sexually transmitted infection (STI) screening warrants consideration, and testicular preservation should be sought when it is a viable management option.
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Affiliation(s)
- Kaitlen S Schexnayder
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, Le bonheur Children's Hospital, Memphis, TN
| | - Vanessa Ortiz-Hernandez
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, Le bonheur Children's Hospital, Memphis, TN
| | - Nicholas J Nordin
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, Le bonheur Children's Hospital, Memphis, TN
| | - Dana W Giel
- Department of Urology, University of Tennessee Health Science Center, Memphis, TN; Division of Pediatric Urology, Le bonheur Children's Hospital, Memphis, TN.
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Paratesticular inflammatory pseudotumour, a rare case. Urol Case Rep 2022; 45:102211. [PMID: 36105543 PMCID: PMC9465314 DOI: 10.1016/j.eucr.2022.102211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 08/24/2022] [Accepted: 08/26/2022] [Indexed: 11/20/2022] Open
Abstract
Paratesticular masses are not infrequent, however the diagnosis is challenging. Differentiation from testicular tumours is of utmost importance. One of the rare forms is a fibrous pseudotumours with only about a couple of hundred cases documented worldwide. We present a case of left paratesticular inflammatory pseudotumour.
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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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Narayan Y, Brown D, Ivaz S, Das K, Moussa M, Tsampoukas G, Papatsoris A, Buchholz N. Incidental testicular masses and the role of organ-sparing approach. Arch Ital Urol Androl 2021; 93:296-300. [PMID: 34839628 DOI: 10.4081/aiua.2021.3.296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES The widespread use of ultrasonography for the investigation of common urological conditions, such as infertility or pain, has resulted in an increased incidence of incidental non-palpable testicular masses. The majority of these are expected to be benign therefore a conservative approach, either active monitoring or organsparing approach, is recommended. However, there are no clinical or radiological parameters which define the exact nature of such lesions and optimal patient selection criteria are lacking. In this comprehensive review we discuss the significance of incidental, small testicular masses (STMs) and the role of organ-sparing approach in the management of these lesions. MATERIALS AND METHODS A non-systematic search was performed using PubMed to identify articles that covered the following topics; clinical implications at diagnosis, role of imaging in identifying the malignant capabilities of a lesion, role of surgery and the final pathology. RESULTS Incidental STMs are routinely identified following ultrasound examination of infertile men. STMs usually measure a few millimeters in size and the majority of these are benign. Therefore, strict follow up or an organ-sparing approach, with utilisation of frozen section analysis (FSA), is favored for STMs. FSA has a high correlation with final pathology and prevents unnecessary orchidectomies. Advances in imaging, namely ultrasound and magnetic resonance imaging may provide enhanced assessment of STMs and guidance intraoperatively. CONCLUSIONS The optimal approach is not well defined and there is no specific clinical parameter that can predict the nature of STMs. The increasing incidence of small, benign testicular masses has resulted in the development of organ-sparing surgery to investigate and manage these lesions. Organ-sparing surgery has been shown to be practical and carries excellent oncological outcomes.
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Affiliation(s)
- Yash Narayan
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Dominic Brown
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Stella Ivaz
- Department of Urology, Princess Alexandra Hospital, Harlow.
| | - Krishanu Das
- U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
| | - Mohamad Moussa
- Al Zahraa Hospital, University Medical Center, Lebanese University, Beirut.
| | - Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital, Harlow; U-merge Ltd. (Urology for emerging countries), London.
| | - Athanasios Papatsoris
- U-merge Ltd. (Urology for emerging countries), London, UK; Consultant Urologist, Bahrain Specialist Hospital.
| | - Noor Buchholz
- U-merge Ltd. (Urology for emerging countries), London.
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9
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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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Miyamoto H. Intraoperative pathology consultation during urological surgery: Impact on final margin status and pitfalls of frozen section diagnosis. Pathol Int 2021; 71:567-580. [PMID: 34154033 DOI: 10.1111/pin.13132] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 05/23/2021] [Indexed: 12/14/2022]
Abstract
Despite recent improvements in diagnostic and surgical techniques in urological oncology, positive resection margin remains a significant concern for surgeons. Meanwhile, intraoperative pathology consultation with frozen section assessment (FSA), particularly for histological diagnosis of the lesions incidentally found or enlarged or sentinel lymph nodes, generally provides critical information which enables immediate decision making for optimal patient care. The intraoperative evaluation of surgical margins is also often requested, although there are some differences in its application between institutions and surgeons. Importantly, it remains to be determined whether intraoperative FSA indeed contributes to reducing the risk of final positive margins and thereby improving long-term patient outcomes. This review summarizes available data indicating the potential impact of FSA at the surgical margins during urological surgeries, including radical or partial cystectomy, partial nephrectomy, radical prostatectomy, penectomy, and orchiectomy. The accuracy and pitfalls of the intraoperative consultation/FSA diagnosis are also discussed.
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Affiliation(s)
- Hiroshi Miyamoto
- Departments of Pathology & Laboratory Medicine and Urology, University of Rochester Medical Center, Rochester, New York, USA
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11
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Favilla V, Cannarella R, Tumminaro A, DI Mauro D, Condorelli RA, LA Vignera S, Ficarra V, Cimino S, Calogero AE. Oncological and functional outcomes of testis sparing surgery in small testicular mass: a systematic review. Minerva Urol Nephrol 2021; 73:431-441. [PMID: 33949185 DOI: 10.23736/s2724-6051.21.04330-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
INTRODUCTION The prevalence of testicular tumor is constantly increasing, with an estimated incidence rate of about 3-10 new cases per 100,000 males/per year. Radical orchiectomy or testis sparing surgery (TSS) are recognized therapeutic approaches in these cases. However, the risk for hypogonadism and infertility is higher with the former compared with the latter. The aim of this systematic review is to evaluate the oncological outcome and testicular function (endocrine and reproductive aspects) in patients who had undergone TSS for small testicular lesions. EVIDENCE ACQUISITION To accomplish this, 684 articles were retrieved and screened; 24 retrospective and two prospective studies were selected and finally included in this systematic review. EVIDENCE SYNTHESIS Overall the TSS attempts were 1096 but TSS was definitively performed in 603 cases (55%). Frozen section examination was performed in 996 TSS attempts (22 out of the 26 studies selected) and showed a benign histology in 37-100% of cases, a malignant histology in 0-63%, and an inconclusive result in 0-16%, respectively. Five studies reported that a total of 22 patients were able to father after conservative surgery. None of these studies reported cases of hypotestosteronemia after surgery and a low prevalence (1.66%) of complications was associated with this type of surgery. CONCLUSIONS In conclusion, TSS showed to be safe and practicable if used according to the specific guidelines. It can be safely performed to treat recurrence eventually associated to local adjuvant radiotherapy when an intra-tubular neoplasia is present. Urologists can therefore consider TSS as an important means against testicular tumor in selected and well-informed patients.
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Affiliation(s)
- Vincenzo Favilla
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Rossella Cannarella
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy -
| | - Antonio Tumminaro
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Davide DI Mauro
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Rosita A Condorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Sandro LA Vignera
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | - Vincenzo Ficarra
- Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy
| | - Sebastiano Cimino
- Section of Urology, Department of Surgery, University of Catania, Catania, Italy
| | - Aldo E Calogero
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Woo LL, Ross JH. Partial orchiectomy vs. radical orchiectomy for pediatric testis tumors. Transl Androl Urol 2020; 9:2400-2407. [PMID: 33209713 PMCID: PMC7658131 DOI: 10.21037/tau-19-815] [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] [Indexed: 11/06/2022] Open
Abstract
While radical orchiectomy remains the gold standard for testicular cancer, partial orchiectomy has become a well-accepted organ-sparing approach for benign testicular tumors in pre-pubertal patients. The aims of testicular-sparing surgery include prevention of over-treatment, preservation of future hormonal and reproductive function, and provision of a durable cure. For pre-pubertal patients, who have a high likelihood of benign lesions, partial orchiectomy provides effective treatment, owing to the high reliability of scrotal ultrasound (US) and intraoperative frozen section. In adolescent and young adult patients, who are more likely to harbor malignant pathology, the role of partial orchiectomy is less clear. Testis-sparing surgery is being reported with greater frequency in the adult literature for small testicular masses and for situations in which radical orchiectomy would result in an anorchia. More recently, a testis-sparing approach has also been described for carefully-selected post-pubertal pediatric patients. This review will highlight the role of partial orchiectomy in pediatric patients (<18 years old).
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Affiliation(s)
- Lynn L Woo
- Department of Pediatric Urology, Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Jonathan H Ross
- Department of Urology, Rush University Medical Center, Chicago, IL, USA
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13
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Partial orchiectomy: The Princess Margaret cancer centre experience. Urol Oncol 2020; 38:605.e19-605.e24. [PMID: 32284257 DOI: 10.1016/j.urolonc.2020.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 02/13/2020] [Accepted: 03/16/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Radical orchiectomy (RO) is the standard treatment for a testis cancer. Organ sparing surgery can be considered in the setting of a solitary functioning testis or bilateral tumors. It has also been suggested as an alternative to RO for small lesions. In this study we report our partial orchiectomy (PO) experience. METHODS We performed a retrospective review using our prospectively maintained database analyzing PO. RESULTS Between 1983 and 2018, 77 patients underwent PO. Mean age was 31.3 years (range 17-56). A lesion was palpable in 70 (90.9%) and median lesion size 14.1 mm (range 3-35 mm). Reasons for PO included ``small lesion" in 39 (50.6%); solitary functioning testis in 30 (39%); bilateral lesions in 6 (7.8%); or assumed benign lesion in 1 (1.3%). Median follow-up was 43.5 months (range 1-258). Lesion histology was benign in 25 (32.5%). A positive surgical margin was noted in 6 (7.8%) with none developing local or distant recurrence. Sixteen (20.8%) patients underwent salvage ipsilateral RO at a median of 3 months (range 0-46). Reasons for salvage RO included a radiologically detected lesion in 7, palpable lesion in 4, positive surgical margin in 3 and adverse pathology in 2 patients. Malignant histology was present in 12 (75%) of the salvage RO specimens. There were no reported Clavien-Dindo Grade 3 to 5 complications. CONCLUSION Organ sparing surgery is a safe and feasible approach to small testis lesions. For the third with benign disease, and even those with malignant histology, a RO can be avoided in carefully selected patients.
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Anheuser P, Kranz J, Stolle E, Höflmayer D, Büscheck F, Mühlstädt S, Lock G, Dieckmann KP. Testicular epidermoid cysts: a reevaluation. BMC Urol 2019; 19:52. [PMID: 31185974 PMCID: PMC6561757 DOI: 10.1186/s12894-019-0477-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/16/2019] [Indexed: 12/05/2022] Open
Abstract
Background Testicular epidermoid cysts (TECs) are rare benign testicular neoplasms. As TECs are rarely associated with germ cell tumours (GCTs), the understanding of biological behaviour and clinical management of TEC is unresolved. Methods We retrospectively searched the files of patients treated for testicular neoplasms and germ cell cancer in the time from 2000 to 2017. Those with TEC were subjected to closer review looking to clinical and histological features, and to results from imaging with ultrasonography (US), contrast enhanced sonography (CEUS) and magnetic resonance imaging (MRI). Results Among 589 patients undergoing surgery for testicular tumour, nine simple TECs were identified (1.5, 95% confidence intervals 0.53–2.50%). Median age was 26 years. Imaging revealed sharply demarcated roundish lesions with avascular central areas. Eight patients underwent testis-sparing excision with no recurrence ensuing. One had orchiectomy because of large size of the mass. Histologically, TECs consisted of cornifying squamous cell epithelium and no accompanying germ cell neoplasia in situ. Two additional cases (0.3% of all) required orchiectomy because these TECs were associated with ipsilateral GCT. Conclusions TEC is usually a benign lesion that can safely be diagnosed with US, CEUS and MRI due to its roundish shape and its avascular centre. Histologically, this TEC corresponds to the prepubertal-type teratoma unrelated to germ cell neoplasia in situ of the 2016 WHO classification. The other subtype of TEC that is associated with invasive GCT represents a teratoma of postpubertal-type. From a clinical point of view it could be easier to differentiate between a “simple TEC” which is benign (prepubertal type) and a “complex TEC” which is malignant because of its association with invasive GCT.
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Affiliation(s)
- Petra Anheuser
- Klinik für Urologie, Albertinen-Krankenhaus, Hamburg, Germany. .,Urologische Klinik AK Wandsbek, Hamburg, Germany.
| | - J Kranz
- Klinik für Urologie und Kinderurologie, St.-Antonius Hospital, Eschweiler, Germany
| | - E Stolle
- Institut für diagnostische und interventionelle Radiologie, Albertinen-Krankenhaus, Hamburg, Germany
| | - D Höflmayer
- Institut für Pathologie, Universitätsklinikum Eppendorf, Universität Hamburg, Hamburg, Germany
| | - F Büscheck
- Institut für Pathologie, Universitätsklinikum Eppendorf, Universität Hamburg, Hamburg, Germany
| | - S Mühlstädt
- Universitätsklink und Poliklinik für Urologie, Martin-Luther-Universität, Halle-Wittenberg, Halle (Saale), Germany
| | - G Lock
- Klinik für Innere Medizin II, Albertinen-Krankenhaus, Hamburg, Germany
| | - K P Dieckmann
- Klinik für Urologie, Albertinen-Krankenhaus, Hamburg, Germany.,Hodenzentrum Hamburg, Asklepios Klink Altona, Hamburg, Germany
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16
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Caldwell BT, Saltzman AF, Maccini MA, Cost NG. Appropriateness for testis-sparing surgery based on the testicular tumor size in a pediatric and adolescent population. J Pediatr Urol 2019; 15:70.e1-70.e6. [PMID: 30448079 DOI: 10.1016/j.jpurol.2018.10.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/02/2018] [Accepted: 10/16/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION In children, most small testicular tumors are benign, and testicular-sparing surgery (TSS) is a viable treatment option. OBJECTIVE The objective of this study is to assess for correlation between the tumor size and final pathologic diagnoses appropriate for TSS for pediatric and adolescent patients with an intratesticular mass and negative serum tumor markers (STMs). MATERIALS AND METHODS A retrospective review of 24 patients (aged 0-18 years) who underwent radical or partial orchiectomy between 2003 and 2015. Patients with unifocal, unilateral intratesticular tumors and negative STMs were included. Tumors with benign and non-germ cell histology were considered appropriate for TSS, and active germ cell tumor elements on final histology were categorized as inappropriate for TSS. Baseline characteristics, tumor size, and frozen section results were evaluated for association, for the entire cohort and then for a subset of pubertal and postpubertal patients (defined as ≥10 years old). RESULTS Patients with testicular tumor pathology inappropriate for TSS were significantly older (median age 17.1 years, P = 0.03). A 2-cm size cutoff did not accurately predict pathology for the entire cohort, or for just pubertal and postpubertal patients (P = 0.132, P = 0.154, respectively). Frozen section and final pathology demonstrated good agreement (κ = 0.826, P < 0.001) as did pre-operative and final pathologic size measurement (κ = 0.703, P < 0.001). Frozen section analysis did not miss a TSS inappropriate pathology. DISCUSSION The present data refute the finding in adults that a 2-cm cutoff accurately predicts pathology in pediatric patients with an intratesticular mass and normal STMs. These data suggest that TSS should still be offered, regardless of the tumor size alone, but frozen section appears to more accurately predict pathology than the tumor size, and its use should, thus, be emphasized. There are several limitations of this study to mention. First, this is a retrospective review of a small cohort of patients with a rare clinical scenario, which necessitated the combination of pediatric and adolescent patients. The study did not evaluate oncologic outcomes. CONCLUSIONS In children with an intratesticular tumor and normal STMs, a tumor size cutoff of 2 cm does not appear to accurately predict the final pathology. However, the data presented support the continued use intra-operative frozen section analysis in both children and adolescents undergoing TSS.
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Affiliation(s)
- B T Caldwell
- Division of Pediatric Urology, Children's Hospital Colorado and Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - A F Saltzman
- Division of Pediatric Urology, Children's Hospital Colorado and Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - M A Maccini
- Division of Pediatric Urology, Children's Hospital Colorado and Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA
| | - N G Cost
- Division of Pediatric Urology, Children's Hospital Colorado and Division of Urology, Department of Surgery, University of Colorado School of Medicine, Aurora, CO, USA.
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Pierconti F, Martini M, Grande G, Larocca LM, Sacco E, Pugliese D, Gulino G, Bassi PF, Milardi D, Pontecorvi A. Germ Cell Neoplasia in situ (GCNIS) in Testis-Sparing Surgery (TSS) for Small Testicular Masses (STMs). Front Endocrinol (Lausanne) 2019; 10:512. [PMID: 31440206 PMCID: PMC6692875 DOI: 10.3389/fendo.2019.00512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/12/2019] [Indexed: 01/26/2023] Open
Abstract
Purpose: The testis-sparing surgery (TSS) is surgical technique accepted for small testicular masses (STMs). Frozen section examination (FSE) is an essential assessment at the time of TSS. The aim of this study is to measure the maximum distance of the foci of ITGCN from STMs. Methods: In our hospital between June 2010 and October 2017 a total of 68 patients with STM underwent a TSS. All the testis specimens were totally embedded and processed via the whole-mount method and a diagnosis of germ cell tumor with GCNIS were made. The distance between STMs and GCNIS were calculated by two pathologists directly on the slides considering for the third dimension the number of the paraffin blocks in which the foci of GCNIS were found. Results: The STMs were classic seminoma in 62 out 68 cases, embryonal carcinoma in 4 cases, while in 2 case a diagnose of mixed germ cell tumor were made. The size of the STMs was between 0.5 and 2 cm and the foci of GCNIS were observed in seminiferous tubules very closed to SMTs or as skip lesions in the surrounding testicular parenchyma, dispersed in normal testis. In 48 out of 68 cases (70.5%) foci of GCNIS were at the distance from SMTS of 1.5 cm or below and in 60 out of 68 cases (88%) at the distance of 2 cm or below The distance of GCNIS from the STMs was not related to the histological subtype of the germ cell tumor, while there is a linear correlation between size of the STMs and the distance of foci of GCNIS (p = 0.0105; r = 0.9167). Conclusion: Our data showed that foci of ITGCN were not observed beyond 2.5 cm from the STM. In particular we demonstrated that exist a linear correlation between size of STMs and distance of the foci of GCNIS from STMs (p = 0.0105; r = 0.9167). In conclusion mapping the tissue around the tumor not randomly but in targeted areas could reduce the false negative biopsies of the testis with GCNIS, increasing the radicality of the TSS procedure.
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Affiliation(s)
- Francesco Pierconti
- Institute of Pathology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- *Correspondence: Francesco Pierconti
| | - Maurizio Martini
- Institute of Pathology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Giuseppe Grande
- Division of Endocrinology, Istituto Scientifico Internazionale “Paolo VI”, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Luigi M. Larocca
- Institute of Pathology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Sacco
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Dario Pugliese
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Gaetano Gulino
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Pier F. Bassi
- Institute of Urology, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Domenico Milardi
- Division of Endocrinology, Istituto Scientifico Internazionale “Paolo VI”, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Alfredo Pontecorvi
- Division of Endocrinology, Istituto Scientifico Internazionale “Paolo VI”, Fondazione Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
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18
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Abstract
OBJECTIVE The purpose of this review is to evaluate the current role of percutaneous testicular biopsy in the diagnosis of focal testicular lesions. CONCLUSION Percutaneous testicular biopsy can be either fine needle aspiration biopsy or trucut core needle biopsy. It is a well-tolerated and effective procedure useful in small testicular lesions, multifocal lesions, hematological malignancies, and focal lesions in single testis.
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Affiliation(s)
- Subramaniyan Ramanathan
- Department of Radiology, Al-Wakra Hospital, Hamad Medical Corporation, PO Box 82228, Doha, Qatar.
- Department of Radiology, Weil Cornell Medical College, Doha, Qatar.
| | - Vikram Dogra
- Department of Imaging Science, University of Rochester Medical Center, 601 Elmwood Ave, Rochester, NY, 14642, USA
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19
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20
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A Case of Fibrous Pseudotumor in the Scrotum: Challenge for Diagnosis and Testicular Preservation. Case Rep Urol 2018; 2018:6904827. [PMID: 29593931 PMCID: PMC5822820 DOI: 10.1155/2018/6904827] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 12/11/2017] [Accepted: 12/20/2017] [Indexed: 12/13/2022] Open
Abstract
A paratesticular fibrous pseudotumor is a relatively rare benign disease. Preoperatively diagnosing a fibrous pseudotumor is challenging because distinguishing these masses from malignant tumors on the basis of clinical and radiological findings can be difficult. We present a case of a 28-year-old man who presented with a painless palpable mass in the right scrotum; the fibrous pseudotumor of the tunica vaginalis was treated with organ-sparing surgery. Computed tomography and magnetic resonance imaging revealed paratesticular tumors. Testicular tumor marker levels were within normal limits. We scheduled the patient to undergo tumor biopsy combined with intraoperative rapid diagnosis. Frozen section assessment suggested a fibrous pseudotumor without malignancy. We successfully performed organ-sparing surgery. Testicular-sparing surgery combined with frozen section assessment is primarily used for treating paratesticular fibrous pseudotumors.
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21
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Oberoi M, Reddy T, Gordetsky JB, Thomas JV, Rais-Bahrami S. Benign testicular neoplasm in a human immunodeficiency virus-positive patient masquerading as testicular cancer. Urol Ann 2017; 9:393-396. [PMID: 29118547 PMCID: PMC5656970 DOI: 10.4103/ua.ua_73_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare, benign neoplasm comprising spindle myoepithelial cells in the background of inflammatory cells. It can involve multiple anatomic sites in the body but rarely involves the testis. We report a case of 52-year-old male patient with a history of human immunodeficiency virus who presented with a painless, testicular mass for 2 months. Despite being treated with prolonged antibiotics and nonsteroidal anti-inflammatory drugs, scrotal ultrasound demonstrated an increase in the size of the lesion. With a presumed diagnosis of testicular germ cell tumor, a right radical inguinal orchiectomy was performed. Microscopic and immunohistochemical features were consistent with testicular IMT, a benign neoplastic process.
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Affiliation(s)
- Mansi Oberoi
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Thanmaya Reddy
- Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jennifer B Gordetsky
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - John V Thomas
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Urology, University of Alabama at Birmingham, Birmingham, AL, USA
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22
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Dharanya S, Vijayakumar C, Sudharsanan S, Jagdish S. A Rare Case Report of a Paratesticular Fibrous Pseudotumor Mimicking a Hydrocele. Cureus 2017; 9:e1565. [PMID: 29057177 PMCID: PMC5640385 DOI: 10.7759/cureus.1565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Tumors arising in the spermatic cord are very rare. The common benign tumors of the spermatic cord include adenomatoid tumor, lipoma, neurofibroma, and leiomyoma. We report a rare case of fibrous pseudotumor of the spermatic cord presenting clinically as a hydrocele. A 28-year-old male presented with the complaint of swelling in the left scrotum, which gradually progressed in size over four years. Clinically, the swelling was soft and fluctuant. The left testis was not separately made out and a diagnosis of left hydrocele was made. On scrotal exploration, a large 12 x 7 cm fleshy mass was seen in the left hemiscrotum with the left testis adherent to the upper pole of the mass. The mass was dissected out from the testis, and the histology showed features of fibrous pseudotumor of the spermatic cord. Fibrous pseudotumor of the spermatic cord is a very rare entity and can pose a diagnostic challenge. Preoperative scrotal ultrasound and intraoperative frozen section assessment can prevent unnecessary orchiectomies in young patients with paratesticular fibrous pseudotumors.
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Affiliation(s)
- Srinivasan Dharanya
- Otorhinolaryngology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chellappa Vijayakumar
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sundaramurthi Sudharsanan
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Sadasivan Jagdish
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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23
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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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24
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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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25
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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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26
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Fresneau B, Orbach D, Faure-Conter C, Verité C, Castex MP, Kalfa N, Martelli H, Patte C. Sex-Cord Stromal Tumors in Children and Teenagers: Results of the TGM-95 Study. Pediatr Blood Cancer 2015. [PMID: 26206391 DOI: 10.1002/pbc.25614] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND We present the results of the TGM-95 study for gonadal sex-cord stromal tumors (SCT). METHODS Between 1995 and 2005, children (<18 years) with gonadal SCT were prospectively registered. Primary gonadal resection was recommended whenever feasible. Patients with disseminated disease or an incomplete resection received neoadjuvant or adjuvant VIP chemotherapy (etoposide, ifosfamide, cisplatinum). RESULTS Thirty-eight children with ovarian SCT were registered. Median age was 10.7y. Endocrine symptoms were present in 21 cases. The histological diagnoses were as follows: juvenile (23) and adult (3) granulosa cell tumors, Sertoli-Leydig cell tumors (11), and mixed germ cell SCT (1). An initial oophorectomy ± salpingectomy led to complete resection in 23 patients who did not receive adjuvant treatment; two of them relapsed: one achieved second complete remission whereas the other one died of disease. Fifteen patients had tumor rupture and/or malignant ascites: 11 received chemotherapy and did not relapse, four did not receive chemotherapy and relapsed with a fatal outcome in two cases. With a median follow-up of 5.9y, the 5-y EFS and OS rates were respectively 85% and 94%. Eleven patients had localized testicular tumors (median age 0.83y): juvenile granulosa cell tumors (4), Sertoli or Leydig cell tumors (5) and not otherwise specified SCT (2). Treatment was surgery alone with an inguinal orchiectomy. None have relapsed (median follow-up: 5.4y). CONCLUSIONS Childhood SCT carry favorable prognosis. In ovarian SCT, surgery should be complete and non-mutilating. Adjuvant chemotherapy efficiently prevents recurrences in cases of tumor rupture. In childhood testicular SCT, the prognosis is excellent with an inguinal orchiectomy, prompting the debate on testis-sparing surgery.
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Affiliation(s)
- Brice Fresneau
- Gustave Roussy, Department of Pediatric Oncology, Villejuif, France
| | - Daniel Orbach
- Institut Curie, Pediatric Adolescent Young Adult Department, Paris, France
| | - Cécile Faure-Conter
- Institut d'Hemato-Oncologie Pediatrique, Department of Pediatric Oncology, Lyon, France
| | - Cécile Verité
- Hôpital Pellegrin, Department of Pediatric Oncology, Bordeaux, France
| | - Marie Pierre Castex
- Centre hospitalier universitaire, Department of Pediatric Oncology, Toulouse, France
| | - Nicolas Kalfa
- Centre hospitalier universitaire, Department of Pediatric Surgery, Montpellier, France
| | - Hélène Martelli
- Centre hospitalier universitaire, Department of Pediatric Surgery, Le Kremlin-Bicêtre, France
| | - Catherine Patte
- Gustave Roussy, Department of Pediatric Oncology, Villejuif, France
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27
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DeCoste RC, Carter MD, Merrimen J. Paratesticular fibrous pseudotumour: Intraoperative frozen section analysis can help prevent unnecessary orchiectomy. Can Urol Assoc J 2015; 9:E731-3. [PMID: 26664509 DOI: 10.5489/cuaj.3110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Paratesticular fibrous pseudotumours are rare intrascrotal lesions, most frequently affecting the testicular tunics. They are benign in nature; however, their pathogenesis is not completely understood. Presenting features are similar to testicular malignancy, which may result in unnecessary radical surgery. It has been suggested that additional diagnostic imaging combined with frozen section analysis may help prevent orchiectomy in these patients. We describe a case of paratesticular fibrous pseudotumour in a 40-year-old male treated with testicle-sparing surgery aided by intraoperative frozen section analysis.
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Affiliation(s)
- Ryan C DeCoste
- Department of Anatomical Pathology, Dalhousie University, Halifax, NS
| | - Michael D Carter
- Department of Anatomical Pathology, Dalhousie University, Halifax, NS
| | - Jennifer Merrimen
- Department of Anatomical Pathology, Dalhousie University, Halifax, NS
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28
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Akan S, Yuksel OH, Ozbay N, Verit A. Testicular fibrous pseudotumour as a rare intrascrotal mass. Rev Int Androl 2015. [DOI: 10.1016/j.androl.2014.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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29
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Woo LL, Ross JH. The role of testis-sparing surgery in children and adolescents with testicular tumors. Urol Oncol 2015; 34:76-83. [PMID: 26094168 DOI: 10.1016/j.urolonc.2015.05.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 05/04/2015] [Accepted: 05/19/2015] [Indexed: 11/28/2022]
Abstract
Organ-sparing approaches have been applied to the treatment of a variety of urologic tumors in both the realms of adult and pediatric urology, with the goals of minimizing overtreatment of benign lesions, preserving function, and providing durable cure. The predominance of benign tumors in prepubertal patients and the reliability of both ultrasound and intraoperative frozen sections have resulted in a marked shift toward testis-sparing approaches over the last few decades. The role of testis sparing in the adolescent population is presently unclear, although there have been increasing reports of successful organ-sparing surgery for testis tumors in the adult literature. This review presents recent trends in testis-sparing approaches for both pediatric and adolescent patients, the operative technique, and some of the controversies related to testis-sparing surgery.
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Affiliation(s)
- Lynn L Woo
- Department of Pediatric Urology, Rainbow Babies & Children׳s Hospital/University Hospitals Case Medical Center, Cleveland, OH.
| | - Jonathan H Ross
- Department of Pediatric Urology, Rainbow Babies & Children׳s Hospital/University Hospitals Case Medical Center, Cleveland, OH
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30
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Ratkal V, Chawla A, Mishra DK, Monappa V. Testicular non-Hodgkin's lymphoma presenting in a young adult. BMJ Case Rep 2015; 2015:bcr-2014-208633. [PMID: 25795748 DOI: 10.1136/bcr-2014-208633] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
We report a case of a 27-year-old man who presented with a slowly growing left testicular swelling associated with mild pain over a period of 3 months. He was evaluated by his family physician with scrotal ultrasound and testicular tumour markers. He was diagnosed and treated as epididymo-orchitis and managed with antibiotics. When he later presented to us, he had an enlarged left testis with normal spermatic cord. Scrotal Doppler evaluation showed a globally enlarged left testis and epididymis with increased vascularity in the left testis, with the right testis being normal. Testicular tumour markers were normal. Fine-needle aspiration cytology of the left testis was suggestive of lymphoma. Exploration through an inguinal approach was carried out and a Chevassu manoeuvre with frozen section study was performed, which was reported as non-Hodgkin's lymphoma. Left radical orchidectomy was performed. Histopathology reported diffuse large B-cell lymphoma, of a germinal centre type. Contrast CT of the abdomen, chest and brain were normal. Sperm cryopreservation was carried out. The patient was started on chemotherapy with cyclophosphamide, hydroxydaunorubicin, oncovin, prednisone (CHOP) regime.
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Affiliation(s)
- Vishal Ratkal
- Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Arun Chawla
- Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Dilip Kumar Mishra
- Department of Urology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
| | - Vidya Monappa
- Department of Pathology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India
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Paratesticular inflammatory myofibroblastic tumor in a pediatric patient. Case Rep Urol 2014; 2014:303678. [PMID: 24900936 PMCID: PMC4036602 DOI: 10.1155/2014/303678] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 04/22/2014] [Indexed: 12/22/2022] Open
Abstract
Although rare, paratesticular inflammatory myofibroblastic tumor (IMT) represents the second most common paratesticular mass after adenomatoid tumor and comprises roughly 6% of such lesions. Only approximately four cases have been reported in patients younger than 18 years of age. We report an incidentally discovered paratesticular IMT in a 17-year-old male successfully treated with wide excision and testis sparing. To our knowledge, no recurrence has been reported after complete excision of paratesticular IMT; however, continued follow-up is recommended.
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Katz M, Ramasamy R, Robinson BD, Rosoff JS. Paratesticular fibrous pseudotumour. BMJ Case Rep 2014; 2014:bcr-2013-203041. [PMID: 24810438 DOI: 10.1136/bcr-2013-203041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 38-year-old man presented with a 2-year history of an enlarging scrotal nodule. Scrotal ultrasound revealed two soft tissue masses separate from the testicle in the right scrotum measuring 1.7 and 0.8 cm. The patient underwent excision of the scrotal nodules, revealing firm, white tissue with a smooth, nodular surface. On histology, the lesions appeared fibrous with scattered capillaries and areas of inflammatory infiltrate consistent with paratesticular fibrous pseudotumour. On a follow-up ultrasound at 6 months, he had no evidence of recurrence.
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Affiliation(s)
- Matthew Katz
- Department of Urology, Weill Cornell Medical College, New York, New York, USA
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Schweyer S. [Rare tumors and tumor-like lesions of the testis and paratesticular structures]. DER PATHOLOGE 2014; 35:256-65. [PMID: 24705999 DOI: 10.1007/s00292-014-1902-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumors and tumor-like lesions of the testes and paratesticular structures are rare neoplasms often documented solely in case reports but are morphologically similar to their counterparts in other organ systems. According to the World Health Organization (WHO) classification, miscellaneous tumors of the testis, tumors of collecting ducts and rete testis, tumors of paratesticular structures are differentiated from mesenchymal tumors of the spermatic cord and testicular adnexa. In the differential diagnostics of a space-occupying mass in the testis or paratesticular region, tumor-like lesions should be considered because these lesions represent a large collection pot and occur more often than was originally assumed.
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Affiliation(s)
- S Schweyer
- Gemeinschaftspraxis Pathologie Starnberg, Am Fuchsengraben 3, 82319, Starnberg, Deutschland,
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Organ-sparing surgery is the treatment of choice in benign testicular tumors. World J Urol 2013; 32:1087-91. [PMID: 24092276 DOI: 10.1007/s00345-013-1174-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2013] [Accepted: 09/16/2013] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Ablation of the testis has been the reference standard for malignant and benign testicular tumors in the past. Nowadays, an organ-sparing surgery (OSS) can be attempted in special cases. Removal of a testis for a benign lesion should be avoided. In this retrospective survey, we analyze the results and long-term follow-up of OSS in benign testicular tumors. METHODS Charts of all patients that underwent OSS because of a benign testicular tumor between 1999 and 2011 at our department were searched and the data from patients were collected. Before surgery, all patients underwent ultrasound (US) and complete staging. Surgery was performed under US or palpation guidance. Frozen-section examination of the tumor and tumor bed biopsies was obtained. All patients underwent postoperative follow-up. We retrospectively reviewed surgical technique, histology, epidemiology, and outcome in all patients. RESULTS In the study period, 40 benign testicular tumors were surgically removed in 37 consecutive patients. Definitive histology did not report of any malignant histopathologic features in all patients. All patients are free of disease after a mean follow-up of 63 months (range 10-120). During this period, two patients developed a second leydig cell tumor (LCT) on the contralateral side; another patient had a second LCT within the same testicle, but on the opposite pole. All patients underwent a subsequent organ-sparing tumor resection. CONCLUSIONS An overtreatment for benign testicular tumors should be avoided. Our initial results indicate that OSS in benign tumors is a safe, feasible treatment for patients.
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Can testis-sparing surgery for small testicular masses be considered a valid alternative to radical orchiectomy? A prospective single-center study. Clin Genitourin Cancer 2013; 11:522-6. [PMID: 23764019 DOI: 10.1016/j.clgc.2013.04.033] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/08/2013] [Accepted: 04/27/2013] [Indexed: 11/21/2022]
Abstract
BACKGROUND The aim of this study was to evaluate the incidence of malignancy in small testicular masses (STMs) treated with testis-sparing surgery (TSS) with intraoperative frozen section analysis and to assess the safety of this surgical procedure. PATIENTS AND METHODS From January 2009 to January 2013, 15 consecutive patients underwent TSS for STMs in a third-referral academic institution. Every patient was preoperatively evaluated with clinical examination and scrotal ultrasonography (US) performed by the same radiologist. Tumor markers were assessed in all cases. All the procedures were performed through inguinal access; the small mass was identified by straight palpation of the testis or with intraoperative ultrasonography (IUS). Frozen-section examination (FSE) was performed in all patients in association with multiple biopsies of the surrounding tissue. Follow-up was carried out in all patients with an ultrasonographic exploration at 6 and 12 months. RESULTS Preoperative tumor markers were normal in all patients. The mean operative time was 90 ± 31 minutes. The warm ischemia time was 18 ± 3 minutes. The mean size on US was 9.5 ± 4.4 mm. FSE results were confirmed by the final pathologic analysis in 14 patients. At final pathologic analysis, 6 patients (40%) were found not to have tumors, another 7 patients (46.7%) had benign neoplasms, and malignant tumor was found in only 2 patients (13.3%). There was no disease recurrence after a mean follow-up of 19.2 ± 11.5 months. CONCLUSION Our experience shows that TSS performed for STMs may represent a safe procedure with optimal results in terms of functional and oncologic end points.
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