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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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Cao L, Chang Q, Sun J, Pang S, Fan Y, Liu J. Absolute monocyte count has a diagnostic role in distinguishing tumor marker-negative TGCT from benign testicular tumor via CCL2 regulation. Medicine (Baltimore) 2023; 102:e34114. [PMID: 37352031 PMCID: PMC10289632 DOI: 10.1097/md.0000000000034114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023] Open
Abstract
Clinically, for testicular tumor patients with negative tumor markers, how to distinguish the malignant from the benign is a difficult problem. This study aimed to assess the clinical significance of the absolute monocyte count (AMC) in differential diagnosis of testicular germ cell tumor with stage S0 (TGCTS0) and benign testicular tumor. In this retrospective single-center study, a total of 90 patients newly diagnosed with benign testicular tumor or TGCTS0 were reviewed. All patients received surgical intervention as the primary treatment method. AMC and other clinicopathological parameters were analyzed. Receiver operating characteristic (ROC) curves were constructed to assess the diagnostic power of investigated parameters, and to determine the optimal cutoff values. Kaplan-Meier curve analysis was used to study the survival of patients with TGCTS0. qRT-PCR and immunohistochemistry (IHC) were performed to examine the expression of C-C motif chemokine ligand 2 (CCL2) mRNA and protein respectively. Differential gene expression and functional enrichment analysis were performed using Gene Expression Omnibus and the Cancer Genome Atlas databases. The mean preoperative AMC in patients with TGCTS0 was significantly higher than that in patients with benign testicular tumor (P = .020). AMC > 0.485*10^9/L was identified to be associated with the presence of TGCTS0 (hazard ratio [HR] = 3.074, P = .026), and patients with higher AMC level had worse progression free survival (PFS) (P = .047). Furthermore, AMC combined with lactate dehydrogenase (LDH) achieved a better diagnostic efficacy for TGCTS0 (area under curve [AUC] = 0.695). Tumor-associated macrophages (TAMs) signature gene CCL2 was highly expressed in TGCT compared with normal testicular tissue. Functional enrichment analysis showed that CCL2 is closely involved in the Extracellular Matrix Organization pathway and positively correlated with the expression of various matrix metalloproteinases (MMPs). Elevated AMC may serve as a predictor of higher risk of TGCTS0, and CCL2 mediated TAMs infiltration and MMPs secretion is essential for the tumorigenesis of TGCT.
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Affiliation(s)
- Li Cao
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Qinzheng Chang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Jiajia Sun
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Shuo Pang
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Yidong Fan
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
| | - Jikai Liu
- Department of Urology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China
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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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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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Fan C, Sun K, Min X, Cai W, Lv W, Ma X, Li Y, Chen C, Zhao P, Qiao J, Lu J, Guo Y, Xia L. Discriminating malignant from benign testicular masses using machine-learning based radiomics signature of appearance diffusion coefficient maps: Comparing with conventional mean and minimum ADC values. Eur J Radiol 2022; 148:110158. [DOI: 10.1016/j.ejrad.2022.110158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 01/04/2022] [Accepted: 01/11/2022] [Indexed: 11/03/2022]
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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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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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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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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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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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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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Schmitt VH, Schmitt C, Hollemann D, Weinheimer O, Mamilos A, Kirkpatrick CJ, Brochhausen C. Tissue expansion of lung bronchi due to tissue processing for histology - A comparative analysis of paraffin versus frozen sections in a pig model. Pathol Res Pract 2019; 215:152396. [PMID: 30954348 DOI: 10.1016/j.prp.2019.03.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/17/2019] [Accepted: 03/24/2019] [Indexed: 10/27/2022]
Abstract
AIM Tissue shrinking due to fixation and processing is well known. However, the degree of shrinking varies significantly with the tissue type as well as the processing method and is not well studied in various tissues. In daily pathological routine workflow, histological specimens from frozen and paraffin sections are performed from the same tissue. In the present study we compared the thickness of bronchus walls obtained from paraffin and frozen sections. METHODS Pig lungs were frozen in ventilated condition in liquid nitrogen and 36 bronchi were isolated after dissection. Frozen sections of 5 μm thickness were performed and the remaining tissue was fixed and embedded in paraffin after fixation in 4% formalin. Frozen and paraffin sections from the same cutting edge were analysed after haematoxylin and eosin staining by measuring the wall thickness of the bronchi using high power fields of 400-fold magnification. In each bronchus 40 measurements were implemented at different wall positions distributed over the entire wall area. Summed up, in each group 1440 wall measurements were performed in total. Statistical analysis was conducted using the Wilcoxon test and t-test as well as Pearson's correlation coefficient with a significance level at P < 0.05. RESULTS The bronchial wall thickness was significantly (p < 0.001) smaller in frozen sections (median: 0.50 mm; min: 0.37 mm; max: 0.97 mm) compared to paraffin sections (median: 0.58 mm; min: 0.35 mm; max: 1.06 mm). The median difference between paraffin and frozen sections was 0.05 mm (min: -0.11 mm; max: 0.22 mm). The wall thickness ratio of both groups was as follows: frozen/paraffin section = 0.8609, thus yielding a difference between paraffin and frozen of 13.91%. High correlation was found between wall thickness measurements on paraffin and frozen sections (R = 0.87, p < 0.001). CONCLUSIONS The bronchus wall thickness in the frozen section was 14% reduced compared to the paraffin section. In routine pathology as well as in scientific studies these results are of relevance, as airway wall thickness represents a relevant marker for pathological interpretation, especially using CT image techniques.
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Affiliation(s)
- Volker H Schmitt
- Cardiology I, Centre for Cardiology, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
| | | | - David Hollemann
- Institute of Clinical and Molecular Pathology, State Hospital Horn, Horn, Austria
| | - Oliver Weinheimer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany; Translational Lung Research Centre Heidelberg (TLRC), German Lung Research Centre (DZL), Im Neuenheimer Feld 430, 69120 Heidelberg, Germany
| | - Andreas Mamilos
- REPAIR-Lab, Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - C James Kirkpatrick
- Institute of Pathology, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany; University Medical Center, Johann Wolfgang Goethe University of Frankfurt, Frankfurt am Main, Germany
| | - Christoph Brochhausen
- REPAIR-Lab, Institute of Pathology, University of Regensburg, Regensburg, Germany; Central Biobank Regensburg, University and University Hospital Regensburg, Franz-Josef-Strauß Allee 11, 93053 Regensburg, Germany.
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He Y, Liao H, Xiang X, Cai D, Qiu L. High-frequency ultrasonography and contrast-enhanced ultrasound for the evaluation of testicular capillary hemangioma: A case report. Medicine (Baltimore) 2019; 98:e14779. [PMID: 30882650 PMCID: PMC6426614 DOI: 10.1097/md.0000000000014779] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
RATIONALE Testicular capillary hemangioma (TCH) is a rare benign tumor of the testis. To the authors' knowledge, there is currently only a few literatures describing the use of contrast-enhanced ultrasound (CEUS) to diagnose TCH. Accurate preoperative diagnosis of benign tumors can avoid orchiectomy. A case of TCH evaluated using high-frequency ultrasound and CEUS is presented. PATIENT CONCERNS A 21-year-old male presented with a right testicular mass during a routine physical examination, and was admitted to the authors' hospital for definitive diagnosis and treatment. DIAGNOSES Combined gray-scale, color Doppler ultrasonography, and CEUS did not exclude the possibility that the right testicular lesion may be a benign tumor. Combined with morphological and immunohistochemical staining results, a pathological diagnosis of TCH was considered. INTERVENTIONS The patient underwent right orchiectomy under general anesthesia, which proceeded smoothly. OUTCOMES At the 12-month follow-up, the patient was completely asymptomatic and resumed all daily activities. LESSONS TCH is a rare benign tumor and lacks extensive previous data in imaging findings. If TCH can be diagnosed accurately before surgery, excessive or inappropriate treatment of benign lesions can be minimized, which will be beneficial to the physical and psychological health of patients.
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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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17
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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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18
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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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19
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Affiliation(s)
- C. Calcagno
- Department of Urology, San Carlo Hospital, Genova Voltri, Italy
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20
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Laclergerie F, Mouillet G, Frontczak A, Balssa L, Eschwege P, Saussine C, Larré S, Cormier L, Vuillemin AT, Kleinclauss F. Testicle-sparing surgery versus radical orchiectomy in the management of Leydig cell tumors: results from a multicenter study. World J Urol 2017; 36:427-433. [PMID: 29230496 DOI: 10.1007/s00345-017-2151-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To compare the oncological outcomes of testicle-sparing surgery (TSS) and radical orchiectomy (RO) in patients with Leydig cell tumor (LCT) of the testis. PATIENTS AND METHODS A multicenter retrospective clinical study was conducted in 12 centers in France. All the patients with histologically proven LCT were included and analyzed according to treatment (organ-sparing surgery or radical orchiectomy). Patients underwent preoperative clinical, biological and imaging assessment. Demographic, clinical, and pathological variables were collected at baseline and compared between groups according to surgical treatment. Follow-up was calculated using the reverse Kaplan-Meier estimation and was updated at the end of 2015. RESULTS Between 1986 and 2014, 56 patients presented with LCT were identified and included in the study. Twenty-one patients (37.5%) underwent TSS and 35 (62.5%) RO. Demographics and tumor characteristics were not significantly different between the groups. Median follow-up was 62 months after TSS, but only 35 months after RO. Two patients (9.5%) developed local recurrence 15 and 34 months after TSS and underwent secondary RO. No local recurrence or metastasis was observed after complementary treatment. No recurrence was observed after RO. Disease-free survival did not differ between the groups (95.2% in TSS versus 77.1% in the RO group, p = 0.23). No patient died in the TSS group, but three patients (8.6%) in the RO group died from other diseases without evidence of relapse. One patient (4.8%) in the TSS group versus five (14.3%) in the RO group were lost to follow-up. CONCLUSION Long-term follow-up suggests that testicle-sparing surgery does not compromise relapse-free survival in the treatment of Leydig cell tumor of the testis.
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Affiliation(s)
- Florian Laclergerie
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France.,University of Burgundy Franche-Comté, 25000, Besancon, France
| | - Guillaume Mouillet
- Department of Medical Oncology, University Hospital of Besancon, 25000, Besancon, France
| | - Alexandre Frontczak
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France.,University of Burgundy Franche-Comté, 25000, Besancon, France
| | - Loïc Balssa
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France.,University of Burgundy Franche-Comté, 25000, Besancon, France
| | - Pascal Eschwege
- Department of Urology, University Hospital of Nancy, 54000, Nancy, France
| | - Christian Saussine
- Department of Urology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Stéphane Larré
- Department of Urology, University Hospital of Reims, 51000, Reims, France
| | - Luc Cormier
- Department of Urology, University Hospital of Dijon, 21000, Dijon, France
| | - Antoine Thiery Vuillemin
- University of Burgundy Franche-Comté, 25000, Besancon, France.,Department of Medical Oncology, University Hospital of Besancon, 25000, Besancon, France.,INSERM, UMR 1098, Besancon, France
| | - François Kleinclauss
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France. .,University of Burgundy Franche-Comté, 25000, Besancon, France. .,INSERM, UMR 1098, Besancon, France.
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21
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Affiliation(s)
- Brian T Caldwell
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA.
| | - Duncan T Wilcox
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA
| | - Nicholas G Cost
- Department of Pediatric Urology, Children's Hospital Colorado, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA; Division of Urology, Department of Surgery, University of Colorado School of Medicine, 13123 E. 16th Avenue, Box 463, Aurora, CO 80045, USA
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22
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The natural history of Leydig cell testicular tumours: an analysis of the National Cancer Registry. Ir J Med Sci 2017; 187:323-326. [PMID: 28726031 DOI: 10.1007/s11845-017-1662-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Leydig cell tumour (LCT) of the testis is a rare histological subtype of stromal tumours, accounting for 1 to 3% of testicular neoplasms. The natural history of LCT is poorly understood. AIMS The aim of this study was to assess the incidence and natural history of Leydig cell tumours (LCT) of the testes. METHODS A search of the National Cancer Registry of Ireland database was performed regarding Leydig cell testicular tumours. Recurrence free survival (RFS) and disease-specific survival (DSS) were analysed. RESULTS Between 1994 and 2013, 2755 new cases of testicular cancer were diagnosed in Ireland. Of these, 22 (0.79%) were Leydig cell tumours. Nineteen were invasive (stage T1) and three were in situ (stage Tis). One patient developed a local recurrence following an organ preserving procedure and underwent a completion orchidectomy 107 days after initial diagnosis. No further treatment was required. There have been no disease-specific deaths. The 1-, 3- and 5-year overall survival (OS) rates were 95.5, 88.2 and 73.3%, respectively. The 5-year disease-specific survival (DSS) was 100% and the 5-year recurrence free survival (RFS) was 93.3%. CONCLUSION From the National Cancer Registry, LCT has been shown to be a rare subtype of testicular tumour. Due to the relatively favourable natural history, it may be possible to tailor less aggressive surveillance regimens in these patients.
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Keske M, Canda AE, Yalcin S, Kilicarslan A, Kibar Y, Tuygun C, Onder E, Atmaca AF, Yildirim A, Ozkanli SS, Kandemir O, Kargi T, Sar M, Tugcu V, Resorlu B, Aslan Y, Sarikaya S, Boylu U, Cicek AF, Basar H, Tuncel A, Balbay MD. Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study. Can Urol Assoc J 2017; 11:E100-E104. [PMID: 28360955 DOI: 10.5489/cuaj.4016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal-appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm. METHODS In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0-1 cm; n=35), Group 2 (1.1-2cm; n=99), and Group 3 (2.1-3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups. RESULTS Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p<0.05 between groups). TIN was detected in 20%, 42.4%, and 41.5% of Groups 1, 2, and 3, respectively (p<0.05 for Group 1 vs. Groups 2 and 3; p>0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p<0.05 for both Group 1 vs. Group 3 and for Group 2 vs. Group 3; p>0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs. >1.5 cm (p>0.05). CONCLUSIONS Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.
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Affiliation(s)
- Murat Keske
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Abdullah Erdem Canda
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | | | | | - Yusuf Kibar
- Gulhane Military Medical Academy, Ankara, Turkey
| | - Can Tuygun
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Evrim Onder
- Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey
| | - Ali Fuat Atmaca
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey; Ankara Yildirim Beyazit University, School of Medicine, Ankara, Turkey
| | - Asif Yildirim
- Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey
| | | | - Olcay Kandemir
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Taner Kargi
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Sar
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Berkan Resorlu
- Ankara Ataturk Training and Research Hospital, Ankara, Turkey
| | - Yilmaz Aslan
- Numune Training and Research Hospital, Ankara, Turkey
| | | | - Ugur Boylu
- Umraniye Training and Research Hospital, Istanbul, Turkey
| | | | - Halil Basar
- Dr. Abdurrahman Yurtaslan Ankara Oncology Training and Research Hospital, Ankara, Turkey
| | - Altug Tuncel
- Numune Training and Research Hospital, Ankara, Turkey
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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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25
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Liu B, Su H, Cheng G, Li P, Hua L, Song N, Wang Z, Gu M. Experiences and outcomes of organ-sparing surgery for testicular tumour with benign tendency. Can Urol Assoc J 2015; 9:E785-8. [PMID: 26600885 DOI: 10.5489/cuaj.2972] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We retrospectively investigated and summarized our experiences and the outcomes of organ-sparing surgery (OSS) for testicular tumour with benign tendency. METHODS From April 2000 to March 2012, 11 selected patients with testicular tumour underwent OSS. Preoperative and postoperative organ functional and oncologic indexes were analyzed and compared. RESULTS All operations were completed without conversion to radical orchiectomy. Intraoperative frozen section and routine postoperative pathology showed tumours with benign tendency. The normal appearance of the scrotum and functional integrity of the testis were preserved. Preoperative and postoperative serum sex hormone levels, international index of erectile function (IIEF-5) scores, and semen quality were not significantly different. Tumour recurrence or metastasis did not occur during follow-up. CONCLUSIONS Our results showed the feasibility and safety of OSS to treat testicular tumour with benign tendency. With careful selection and rigorous follow-up, some testis tumor can be treated with OSS to maximally maintain normal appearance and function of the testis. The retrospective single-centre study and small sample size are main limitations. More evidence is needed to establish the large-scale application of OSS.
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Affiliation(s)
- Bianjiang Liu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Huang Su
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Gong Cheng
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Pengchao Li
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Lixin Hua
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ninghong Song
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Zengjun Wang
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min Gu
- Department of Urology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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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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Silverio PC, Schoofs F, Iselin CE, Tille JC. Fourteen-year experience with the intraoperative frozen section examination of testicular lesion in a tertiary university center. Ann Diagn Pathol 2015; 19:99-102. [PMID: 25747842 DOI: 10.1016/j.anndiagpath.2014.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 12/15/2014] [Accepted: 12/15/2014] [Indexed: 11/18/2022]
Abstract
Most testicular tumors are germ cell neoplasias. The number of incidentally detected small-sized, nonpalpable testicular lesions is increasing with the use of high-frequency ultrasound for infertility or trauma. These lesions are benign in 80% of cases and can be treated by organ-sparing surgery on the basis of frozen section examination (FSE). We assess the reliability of FSE in testicular and paratesticular lesions and its possible impact on surgical management. We performed a retrospective review of intraoperative FSE in testicular/paratesticular lesions at Geneva University Hospital during a 14-year period. A total of 170 cases were identified, with 159 testicular and 11 paratesticular lesions. The FSE results, permanent sections, and orchiectomy slides were reviewed and compared. Frozen section examinations were reported to be benign in 9 paratesticular and in 43 testicular lesions, and malignant in 2 paratesticular and 105 testicular lesions. Comparing FSE and final diagnosis, FSE correctly identified all nontumor lesions. There was a failure rate of 3.5% to identify tumor. Specificity was 100%, sensitivity was 95%, positive predictive value was 100%, and negative predictive value was 89%. Frozen section examination is a highly sensitive and specific intraoperative procedure, which allows to differentiate between benign and malignant testicular and paratesticular lesions, with a possibility of organ-sparing surgery when they are benign.
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Affiliation(s)
| | - Fabian Schoofs
- Division of Urology Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Christophe E Iselin
- Division of Urology Surgery, Geneva University Hospitals, Geneva, Switzerland
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Leonhartsberger N, Pichler R, Stoehr B, Horninger W, Steiner H. Organ Preservation Technique Without Ischemia in Patients With Testicular Tumor. Urology 2014; 83:1107-11. [DOI: 10.1016/j.urology.2013.12.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 12/10/2013] [Accepted: 12/13/2013] [Indexed: 11/28/2022]
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Mahdavi-Zafarghandi R, Shakiba B, Ameli M. Testis-sparing surgery in testicular mass: Testicular epidermoid cysts. Can Urol Assoc J 2014; 8:E101-3. [PMID: 24554971 DOI: 10.5489/cuaj.1588] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
We present 3 patients with testicular epidermoid cysts who experienced testis-sparing surgery. These patients had a palpable painless testicular mass and underwent inguinal testicular exploration. Intraoperative frozen section revealed no evidence of malignancy and therefore enucleation of the tumour was performed. We demonstrate that careful intraoperative frozen-section examination helps to avoid unnecessary orchidectomy in testicular epidermoid cysts.
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Affiliation(s)
- Reza Mahdavi-Zafarghandi
- Department of Urology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Behnam Shakiba
- Department of Urology, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mojtaba Ameli
- Department of Urology, Gonabad University of Medical Sciences, Gonabad, Iran
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Ondo CZ, Sarr A, Sow Y, Thiam I, Fall B, Sow D, Thiam A, Diao B, Fall P, Gaye G, Ndoye A, Ba M, Diagne B. Bilharziome testiculaire à Schistosomia haematobium : à propos de deux observations. Prog Urol 2014; 24:67-9. [DOI: 10.1016/j.purol.2013.04.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Revised: 04/03/2013] [Accepted: 04/17/2013] [Indexed: 11/16/2022]
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31
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Uzun H, Oğullar S, Şehitoğlu İ, Akça G, Zorba OÜ. Testis sparing surgery in a case of small unilateral testicular cancer. Turk J Urol 2013; 39:270-3. [PMID: 26328122 DOI: 10.5152/tud.2013.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Accepted: 05/15/2013] [Indexed: 11/22/2022]
Abstract
A 22-year-old male presented at our institution with an incidentally ultrasound-detected testicular tumor. Magnetic resonance imaging showed a contrast-enhanced right intratesticular mass over 1 cm in size. The patient underwent testis sparing surgery. Pathologic examination revealed seminoma. A follow-up nine months later showed no residual tumor, a normal contour of the testis and no evidence of atrophy. Testis sparing surgery is an option for patients with small unilateral testicular tumors even in the presence of a healthy contralateral testis.
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Affiliation(s)
- Hakkı Uzun
- Department of Urology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Sabri Oğullar
- Deparment of Radiology, Rize Education and Research Hospital, Rize, Turkey
| | - İbrahim Şehitoğlu
- Department of Pathology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Görkem Akça
- Department of Urology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
| | - Orhan Ünal Zorba
- Department of Urology, Faculty of Medicine, Recep Tayyip Erdoğan University, Rize, Turkey
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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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34
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Long-term follow up with sparing surgery for testicular diseases: A safe choice in benign testicular lesions. Rev Int Androl 2013. [DOI: 10.1016/j.androl.2013.06.002] [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]
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35
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Hor KC, Tan CY, Spernat D. Testes sparing surgery for bilateral testicle masses. ANZ J Surg 2013; 83:397-8. [PMID: 23614892 DOI: 10.1111/ans.12124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Subik MK, Gordetsky J, Yao JL, di Sant'Agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: its role in preventing unnecessary orchiectomy. Hum Pathol 2012; 43:1514-9. [DOI: 10.1016/j.humpath.2011.11.013] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 11/10/2011] [Accepted: 11/16/2011] [Indexed: 11/25/2022]
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37
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Testing testes: problems and recent advances in the diagnosis of testicular tumours and implications for treatment. Clin Oncol (R Coll Radiol) 2011; 24:30-8. [PMID: 21925852 DOI: 10.1016/j.clon.2011.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 06/14/2011] [Accepted: 07/05/2011] [Indexed: 11/22/2022]
Abstract
The low incidence of testicular tumours and the fact that they show an extremely high diversity means that they may be poorly understood. Knowledge of the range of tumours and the differences in treatment available is essential for appropriate management. The advent of cisplatin chemotherapy and the exquisite sensitivity of seminoma to radiotherapy have resulted in excellent cure rates. Nevertheless, research has continued unabated, particularly to understand the molecular basis of germ cell tumours and why certain tumours are recalcitrant to treatment. This overview is an attempt to demystify areas of confusion and highlight areas of current interest in testicular pathology and oncology.
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Giannarini G, Mogorovich A, Bardelli I, Manassero F, Selli C. Testis-sparing surgery for benign and malignant tumors: A critical analysis of the literature. Indian J Urol 2011; 24:467-74. [PMID: 19468498 PMCID: PMC2684381 DOI: 10.4103/0970-1591.44249] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
In order to explore the latest advances in organ-sparing treatment of testicular tumors, a literature search of the Medline/PubMed database was carried out for published data in the English language up to 2007. In the recent past the management of testicular tumors has evolved in favor of a testis-sparing approach in selected cases, both in the adult and pediatric population. The widespread use of high-frequency testicular ultrasound has led to detecting an increasing number of asymptomatic, non-palpable, small-volume masses. A higher proportion of testicular lesions of benign nature than previously reported has now been documented. The high accuracy of frozen section examination and the increasing interest in the potential functional, psychological and cosmetic advantages related to preserved testicular parenchyma are other arguments currently favoring the adoption of an organ-sparing policy for most testicular masses. Greater experience has been gained in also managing conservatively malignant tumors. Patients with germ-cell cancer in solitary testis or bilateral tumors can be submitted to testis-sparing surgery, provided that the maximum size of the lesion is <2 cm, preoperative testosterone is normal and adjuvant radiotherapy of the residual parenchyma is delivered. Cancer-specific survival is excellent, local recurrence rate very low and androgen supplementation unlikely.
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39
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Heer R, Jackson MJ, El-Sherif A, Thomas DJ. Twenty-nine Leydig cell tumors: Histological features, outcomes and implications for management. Int J Urol 2010; 17:886-9. [DOI: 10.1111/j.1442-2042.2010.02616.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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40
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Organ-Sparing Surgery for Adult Testicular Tumours: A Systematic Review of the Literature. Eur Urol 2010; 57:780-90. [DOI: 10.1016/j.eururo.2010.01.014] [Citation(s) in RCA: 152] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2009] [Accepted: 01/08/2010] [Indexed: 11/18/2022]
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41
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Toren PJ, Roberts M, Lecker I, Grober ED, Jarvi K, Lo KC. Small Incidentally Discovered Testicular Masses in Infertile Men—Is Active Surveillance the New Standard of Care? J Urol 2010; 183:1373-7. [DOI: 10.1016/j.juro.2009.12.012] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Indexed: 11/15/2022]
Affiliation(s)
- Paul J. Toren
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Matthew Roberts
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Irene Lecker
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Ethan D. Grober
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Keith Jarvi
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Kirk C. Lo
- Division of Urology, Department of Surgery, Mount Sinai Hospital and New Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
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Loeser A, Vergho DC, Katzenberger T, Brix D, Kocot A, Spahn M, Gerharz EW, Riedmiller H. Testis-sparing Surgery Versus Radical Orchiectomy in Patients With Leydig Cell Tumors. Urology 2009; 74:370-2. [DOI: 10.1016/j.urology.2009.03.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/03/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
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43
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Suardi N, Strada E, Colombo R, Freschi M, Salonia A, Lania C, Cestari A, Carmignani L, Guazzoni G, Rigatti P, Montorsi F. Leydig cell tumour of the testis: presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience. BJU Int 2009; 103:197-200. [DOI: 10.1111/j.1464-410x.2008.08016.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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44
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A case of synchronous bilateral testicular seminoma. ACTA ACUST UNITED AC 2008; 5:397-401. [DOI: 10.1038/ncpuro1133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2007] [Accepted: 04/22/2008] [Indexed: 11/08/2022]
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Algaba F, Arce Y, Santaularia JM, Villavicencio Mavrich H. [Frozen section in urological oncology]. Actas Urol Esp 2008; 31:945-56. [PMID: 18257364 DOI: 10.1016/s0210-4806(07)73758-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The indications of Frozen section diagnosis (FS) in surgery due to urologic neoplasia are quite specific, and this explains the fact that they amount to a mere 7.3% of the FSs performed in general hospitals. This also makes the knowledge of their usefulness necessary, and thus we are submitting the present review. Generally speaking, FS is not warranted to identify the nature of a tumoral mass, with the following exceptions: (1) Renal masses of a doubtf ul parenchymal origin, or in the urinary tract: (2) Intesticular neoplasias,when the possibility of a conservative treatment arises; (3) Determination of the presence of a prostate adenocarcinoma in an organ donor with high serum PSA; but even in these circumstances its need is widely controversial. Intraoperative determination of surgical margins is particularly useful in: (1) Partial nephrectomies (it may be limited to inspection after dyeing the margin with Indian ink--bed freezing is very seldom needed); (2) Urethral margins in women with total cystectomies and orthotopic substitution; (3) In partial penectomies (always studying the urethral margin and the cavernosal and spongIosal corpora margins). The study of the nodes is a widely debated issue, and except for those cases in which unexpectedly increased node size is found, systematic FS is indicated neither of the bladder nor of the prostate. The situation regarding penis carcinoma is different, as in the groups with intermediate and high risk of node metastasis, even though there is around 16%-18% of false negatives FS is recommended, particularly of radioisotope-marked sentinel nodes.
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Affiliation(s)
- F Algaba
- Sección de Patología, Fundación Puigvert, Barcelona.
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46
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Giannarini G, Mogorovich A, Menchini Fabris F, Morelli G, De Maria M, Manassero F, Loggini B, Pingitore R, Cavazzana A, Selli C. Long-term followup after elective testis sparing surgery for Leydig cell tumors: a single center experience. J Urol 2007; 178:872-6; quiz 1129. [PMID: 17631320 DOI: 10.1016/j.juro.2007.05.077] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Indexed: 11/19/2022]
Abstract
PURPOSE Although most Leydig cell tumors are benign, radical orchiectomy is currently considered the standard therapy. We retrospectively analyzed the long-term followup of a series of patients with Leydig cell tumors electively treated with testis sparing surgery. MATERIALS AND METHODS Between November 1990 and December 2005, 17 consecutive patients with Leydig cell tumors underwent testis sparing surgery on an elective basis. Preoperative evaluation included physical examination, serum markers for germ cell tumors, scrotal ultrasound, abdominal computerized tomography, chest x-ray and hormonal profile if clinically required. Testis sparing surgery was performed via an inguinal approach with spermatic cord clamping. Frozen section examination was performed in all cases, revealing Leydig cell tumors. Followup consisted of physical examination, scrotal ultrasound, abdominal computerized tomography and chest x-ray every 6 months for the first 2 years, then annually. Tumor recurrence and survival were evaluated. RESULTS Mean patient age was 41.6 years (range 28 to 55). Medical referral was prompted by symptoms/signs such as infertility, gynecomastia or self-palpation of scrotal mass in 11 patients (64.7%), while in the remaining 6 (35.3%) the lesions were incidentally diagnosed. Hormonal profile was performed in 9 patients, showing abnormalities in all. Mean tumor diameter was 13.4 mm (range 5 to 31). Definitive pathological examination confirmed benign Leydig cell tumor in all cases. After a mean followup of 91 months (range 12 to 192), neither local recurrence nor distant metastases have been detected and all patients are alive without evidence of disease. CONCLUSIONS In patients with Leydig cell tumors testis sparing surgery with frozen section examination provides an excellent long-term oncological outcome.
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Giannarini G, Menchini Fabris F, Mogorovich A, Morelli G. Re: Long-term follow-up and clinical characteristics of testicular Leydig cell tumor: experience with 24 cases. J Urol 2007; 177:1955. [PMID: 17437857 DOI: 10.1016/j.juro.2007.01.043] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2006] [Indexed: 10/23/2022]
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Connolly SS, D'Arcy FT, Gough N, McCarthy P, Bredin HC, Corcoran MO. Carefully selected intratesticular lesions can be safely managed with serial ultrasonography. BJU Int 2006; 98:1005-7; discussion 1007. [PMID: 17034602 DOI: 10.1111/j.1464-410x.2006.06451.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To evaluate a policy of conservative non-operative management for incidental, impalpable, < 1 cm, intratesticular pathology. PATIENTS AND METHODS We retrospectively reviewed all scrotal ultrasonograms within an 8-year period to identify all radiological lesions of < 1 cm within the testis. All palpable lesions and those accompanied by elevated tumour markers or disseminated malignancy were managed surgically. The remaining incidentally detected lesions were followed with a protocol of serial ultrasonography (US). RESULTS Of 1544 scans reviewed, 12 (0.8%) lesions suitable for observational management were identified. The mean (range) age of the patients was 54 (34-76) years. The indication for US was suspected epididymitis in five, contralateral epididymal cyst in five and infertility in two patients. The mean (range) size of the lesion was 4.9 (1.5-9.8) mm. Three anechoic lesions were consistent with intratesticular cysts, and each was followed with no change to a mean (range) follow-up of 26 (12-48) months. Eight hypoechoic lesions were followed to a mean of 34 (4-72) months, and only one showed growth on repeat US after an interval of 4 months, and was diagnosed as a 1.0-cm seminoma after orchidectomy. One hyperechoic lesion remains unchanged at 6 months of follow-up. CONCLUSION Supported by previous reports suggesting that most testis lesions of < 1 cm are benign, we managed a series of carefully selected intratesticular lesions conservatively, the behaviour in most being in keeping with benign pathology.
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Affiliation(s)
- Stephen S Connolly
- Department of Urology, University College Hospital Galway, National University of Ireland, Galway, Ireland.
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