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Pozza C, Tenuta M, Sesti F, Bertolotto M, Huang DY, Sidhu PS, Maggi M, Isidori AM, Lotti F. Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice. Cancers (Basel) 2023; 15:5332. [PMID: 38001591 PMCID: PMC10670367 DOI: 10.3390/cancers15225332] [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: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. METHODS An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. RESULTS A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein. CONCLUSIONS The mp-US characterization of TL reported herein can be useful in daily clinical practice.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Michele Bertolotto
- Department of Radiology, Ospedale Di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Dean Y. Huang
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Paul S. Sidhu
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Loehr AR, Timmerman DM, Liu M, Gillis AJ, Matthews M, Bloom JC, Nicholls PK, Page DC, Miller AD, Looijenga LH, Weiss RS. Analysis of a mouse germ cell tumor model establishes pluripotency-associated miRNAs as conserved serum biomarkers for germ cell cancer detection. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.09.09.556995. [PMID: 37745561 PMCID: PMC10515752 DOI: 10.1101/2023.09.09.556995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Malignant testicular germ cells tumors (TGCTs) are the most common solid cancers in young men. Current TGCT diagnostics include conventional serum protein markers, but these lack the sensitivity and specificity to serve as accurate markers across all TGCT subtypes. MicroRNAs (miRNAs) are small non-coding regulatory RNAs and informative biomarkers for several diseases. In humans, miRNAs of the miR-371-373 cluster are detectable in the serum of patients with malignant TGCTs and outperform existing serum protein markers for both initial diagnosis and subsequent disease monitoring. We previously developed a genetically engineered mouse model featuring malignant mixed TGCTs consisting of pluripotent embryonal carcinoma (EC) and differentiated teratoma that, like the corresponding human malignancies, originate in utero and are highly chemosensitive. Here, we report that miRNAs in the mouse miR-290-295 cluster, homologs of the human miR-371-373 cluster, were detectable in serum from mice with malignant TGCTs but not from tumor-free control mice or mice with benign teratomas. miR-291-293 were expressed and secreted specifically by pluripotent EC cells, and expression was lost following differentiation induced by the drug thioridazine. Notably, miR-291-293 levels were significantly higher in the serum of pregnant dams carrying tumor-bearing fetuses compared to that of control dams. These findings reveal that expression of the miR-290-295 and miR-371-373 clusters in mice and humans, respectively, is a conserved feature of malignant TGCTs, further validating the mouse model as representative of the human disease. These data also highlight the potential of serum miR-371-373 assays to improve patient outcomes through early TGCT detection, possibly even prenatally.
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Affiliation(s)
- Amanda R. Loehr
- Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | | | - Michelle Liu
- Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | - Ad J.M. Gillis
- Princess Máxima Center for Pediatric Oncology, Utrecht, Netherlands
| | - Melia Matthews
- Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | | | | | - David C. Page
- Whitehead Institute, Cambridge, MA
- Howard Hughes Medical Institute, Whitehead Institute, Cambridge, MA
- Department of Biology, Massachusetts Institute of Technology, Cambridge, MA
| | - Andrew D. Miller
- Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
| | | | - Robert S. Weiss
- Department of Biomedical Sciences, Cornell University College of Veterinary Medicine, Ithaca, NY
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3
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Chavarriaga J, Hamilton R. Small Testicular Masses: Contemporary Diagnostic and Treatment Strategies, Future Directions, and Knowledge Gaps. Urol Oncol 2023:S1078-1439(23)00081-9. [PMID: 36990940 DOI: 10.1016/j.urolonc.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/20/2023] [Accepted: 02/28/2023] [Indexed: 03/29/2023]
Abstract
The incidental discovery of small masses in the testicles of young men is becoming an increasing clinical dilemma. We are learning that the malignancy rate in masses ≤ 2 cm is much lower than traditionally thought and could be as low as 13% to 21%. The challenge remains in identifying which of these patients harbor malignant tumors that need to be treated, and benign lesions that could be safely surveilled. The aim of this narrative review is to discuss the current scientific evidence, diagnostic work-up, and treatment strategies for small testicular masses. We also discuss selection criteria, follow-up schedules and triggers for intervention for the surveillance of these small testis masses. Furthermore, we give a set of recommendations for assessing and treating these patients, based on the available literature and our experience at a dedicated testicular cancer clinic.
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Smriti V, Baheti AD, Shah S, Qureshi SS, Shetty N, Gala K, Kulkarni S, Raut A, Kamble V, Chinnaswamy G, Prasad M, C. P B, Ramadwar M, Singh S, Shukla A, Panwala H, Sahu A, Siddharth L, Kapadia T. Imaging Recommendations for Diagnosis, Staging, and Management of Pediatric Solid Tumors. Indian J Med Paediatr Oncol 2023. [DOI: 10.1055/s-0042-1759507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
AbstractPaediatric extra-cranial solid tumours are one of the common causes for paediatric malignancies. Lack of appropriate imaging at presentation, staging and for follow-up is a major challenge for paediatric solid tumours. We have reviewed the paediatric solid tumour imaging protocols suggested by the major oncological societies/groups around the world (mainly the SIOP – Society International Pediatric Oncology, and the COG – Children's Oncology Group). We have adapted some of those protocols to develop imaging recommendations for the diagnosis, staging and management of extra-cranial solid tumours based on the treatment protocols followed in India.
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Affiliation(s)
- Vasundhara Smriti
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Akshay D. Baheti
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sneha Shah
- Department of Nuclear Medicine and molecular imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Sajid S. Qureshi
- Division of Pediatric Surgical Oncology, Department of Surgical Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Nanadan Shetty
- Department of Opthalmology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Kunal Gala
- Department of Intervention Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suyash Kulkarni
- Department of Intervention Radiology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Abhijit Raut
- Department of Radiodiagnosis, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Veenita Kamble
- Department of Radiodiagnosis, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
| | - Girish Chinnaswamy
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Maya Prasad
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Badira C. P
- Department of Pediatric Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Mukta Ramadwar
- Department of Pathology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Suryaveer Singh
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Anuradha Shukla
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Hirenkumar Panwala
- Department of Radiodiagnosis, SRCC Children's Hospital, Mumbai, Maharashtra, India
| | - Arpita Sahu
- Department of Radiodiagnosis and Imaging, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Laskar Siddharth
- Department of Radiation Oncology, Homi Bhabha National Institute, Tata Memorial Hospital, Mumbai, Maharashtra, India
| | - Tejas Kapadia
- Children's X-ray Department/Academic Unit of Paediatric Radiology, Royal Manchester Children's Hospital, Manchester, United Kingdom
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Dieckmann KP, Isbarn H, Grobelny F, Dumlupinar C, Utschig J, Wülfing C, Pichlmeier U, Belge G. Testicular Neoplasms: Primary Tumour Size Is Closely Interrelated with Histology, Clinical Staging, and Tumour Marker Expression Rates-A Comprehensive Statistical Analysis. Cancers (Basel) 2022; 14:5447. [PMID: 36358866 PMCID: PMC9653836 DOI: 10.3390/cancers14215447] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/09/2022] Open
Abstract
The role of primary tumour size (TS) in the clinical course of testicular tumours is incompletely understood. We retrospectively evaluated 641 consecutive patients with testicular neoplasms with regard to TS, histology, clinical stage (CS), serum tumour marker (STM) expression and patient age using descriptive statistical methods. TS ≤ 10 mm was encountered in 13.6% of cases. Median TS of 10 mm, 30 mm, 35 mm, and 53 mm were found in benign tumours, seminomas, nonseminomas, and other malignant tumours, respectively. In cases with TS ≤ 10 mm, 50.6% had benign tumours. Upon receiver operating characteristics analysis, TS of > 16 mm revealed 81.5% sensitivity and 81.0% specificity for detecting malignancy. In subcentimeter germ cell tumours (GCTs), 97.7% of cases had CS1, and CS1 frequency dropped with increasing TS. Expression rates of all STMs significantly increased with TS. MicroRNA-371a-3p (M371) serum levels had higher expression rates than classical STMs, with a rate of 44.1% in subcentimeter GCTs. In all, TS is a biologically relevant factor owing to its significant associations with CS, STM expression rates and histology. Importantly, 50% of subcentimeter testicular neoplasms are of benign nature, and M371 outperforms the classical markers even in subcentimeter tumours.
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Affiliation(s)
| | - Hendrik Isbarn
- Martini Klinik, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Francesca Grobelny
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Cansu Dumlupinar
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
| | - Julia Utschig
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, D-22763 Hamburg, Germany
| | - Uwe Pichlmeier
- Institute of Medical Biometry und Epidemiology, Universitätsklinikum Eppendorf, Martinistrasse 52, D-20251 Hamburg, Germany
| | - Gazanfer Belge
- Tumour Genetics Department, Faculty of Biology and Chemistry, Tumour Genetics, University of Bremen, Leobener Strasse 2/FVG, 28359 Bremen, Germany
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Belfield J, Findlay-Line C. Testicular Germ Cell Tumours—The Role of Conventional Ultrasound. Cancers (Basel) 2022; 14:cancers14163882. [PMID: 36010875 PMCID: PMC9405778 DOI: 10.3390/cancers14163882] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 08/04/2022] [Accepted: 08/10/2022] [Indexed: 11/16/2022] Open
Abstract
Testicular tumours are the most common tumours found in young males and germ cell tumours account for 95% of testicular tumours. Ultrasound is the first-line radiological investigation for imaging of the testis. This article outlines how to undertake an ultrasound examination, including optimal patient position, scanning technique and imaging parameters. Classification of germ cell tumours is provided, and salient imaging features of different tumours are described. Difficulties and pitfalls of ultrasound are described, including tumours found after a trauma presentation, orchitis causing diagnostic difficulties and imaging of small testicular lesions. Other uses of ultrasound are outlined, including looking for a primary testicular tumour following the discovery of retroperitoneal lymph nodes, imaging when tumour-makers increase, local recurrence in the scrotum, and for solid organ biopsy in metastatic disease. Conclusion: Ultrasound remains the first-line of investigation for imaging of the testis, and conventional ultrasound still plays a large role in imaging. On ultrasound alone, accurate morphological characterisation of tumours remains a challenge, despite the imaging features that can be seen in different tumour types. Therefore, histology following orchidectomy of a germ cell tumour remains the gold standard for accurate tumour characterisation.
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7
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Maulana R, Siregar S, Hernowo BS. Testicular Epidermoid Cyst: A Rare Case Report. Int J Surg Case Rep 2022; 94:107167. [PMID: 35658319 PMCID: PMC9097686 DOI: 10.1016/j.ijscr.2022.107167] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION AN IMPORTANCE Testicular epidermoid cysts (TECs) are rare benign testicular neoplasms. Recently, testicular epidermoid cysts (TECs) are listed as teratoma of prepubertal type, however it is still difficult to differentiate the epidermoid cyst from malign testicular tumor. Therefore, we would like to report testicular epidermoid cyst at our institution. CASE PRESENTATION A 67-year-old man from Indonesia, presented with chronical painless mass of testis since one year ago. On physical examination obtained normal penile structure with descended testicles, palpable intrascrotal mass with size of 10 × 7 × 5 cm, firm consistency, immobile, without any tenderness, and no lymphadenophaty in groin. Scrotal USG showed intratesticular mass, homogenous parenchym, showed no vascularization during Doppler examination. Histopathological examination revealed the specimen of right scrotum with size of 12.5 cm × 8.5 cm × 6.1 cm with red-brownish colored, during lamellation, obtained encapsulated mass with size of 12.2 cm × 7.9 cm × 6 cm, hollowed space filled with porridge-like texture with capsule thickness of 0.1-0.3 cm. CLINICAL DISCUSSION Epidermoid cysts are benign lesions occurring on the skin usually, however, it rarely occurs in intratesticular area. Most of the cases (60%) presented with the typical onion-ring phenomenon. Histopathological findings commonly revealed typical well-defined cyst lined by a fibrous membrane. No skin appendages are found in the cyst's lumen and no germ cell neoplasm (GCN) is present in the adjacent testicular parenchyma. CONCLUSION All testicular masses are considered malignant until proven otherwise. It is necessary to do accurate diagnosis for the prevention of unnecessary radical orchiectomy.
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Affiliation(s)
- Reza Maulana
- Urology Department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, Indonesia; Urology Department, Universitas Syiah Kuala, Aceh, Indonesia.
| | - Safendra Siregar
- Urology Department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, Indonesia
| | - Bethy S Hernowo
- Pathology Anatomy Department, Hasan Sadikin Academic Medical Center, Universitas Padjadjaran, Bandung, Indonesia
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Khatri G, Bhosale PR, Robbins JB, Akin EA, Ascher SM, Brook OR, Dassel M, Glanc P, Henrichsen TL, Learman LA, Sadowski EA, Saphier CJ, Wasnik AP, Maturen KE. ACR Appropriateness Criteria® Newly Diagnosed Palpable Scrotal Abnormality. J Am Coll Radiol 2022; 19:S114-S120. [PMID: 35550796 DOI: 10.1016/j.jacr.2022.02.018] [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: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 11/29/2022]
Abstract
Palpable scrotal abnormalities are caused by a variety of disorders, ranging from indolent benign conditions to aggressive tumors, and infectious and vascular processes. In these patients the diagnostic workup typically begins with a complete clinical, history, and physical examinations, including analysis of risk factors. If imaging is required, ultrasound examination is the diagnostic modality of choice. In few select patients with very large scrotal masses, MRI may be appropriate. However, the use of gadolinium-based contrast should be evaluated critically depending on specific patient factors. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision include an extensive analysis of current medical literature from peer reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation or GRADE) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where evidence is lacking or equivocal, expert opinion may supplement the available evidence to recommend imaging or treatment.
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Affiliation(s)
- Gaurav Khatri
- Division Chief, Body MRI; Associate Division Chief, Abdominal Imaging; Program Director, Body MRI Fellowship, UT Southwestern Medical Center, Dallas, Texas.
| | | | | | - Esma A Akin
- George Washington University Hospital, Washington, District of Columbia
| | - Susan M Ascher
- Georgetown University Hospital, Washington, District of Columbia
| | - Olga R Brook
- Section Chief of Abdominal Radiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mark Dassel
- Director Endometriosis and Chronic Pelvic Pain, Cleveland Clinic, Cleveland, Ohio; American College of Obstetricians and Gynecologists
| | - Phyllis Glanc
- University of Toronto and Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Lee A Learman
- Dean, Virginia Tech Carilion School of Medicine, Roanoke, Virginia; American College of Obstetricians and Gynecologists
| | - Elizabeth A Sadowski
- University of Wisconsin, Madison, Wisconsin; and ACR O-RADS MRI Education Subcommittee Chair
| | - Carl J Saphier
- Women's Ultrasound, LLC, Englewood, New Jersey; American College of Obstetricians and Gynecologists
| | - Ashish P Wasnik
- Division Chief, Abdominal Radiology, University of Michigan, Ann Arbor, Michigan
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Contrast-enhanced and microvascular ultrasound imaging features of testicular lymphoma: report of five cases and review literature. BMC Urol 2022; 22:6. [PMID: 35067228 PMCID: PMC8785503 DOI: 10.1186/s12894-022-00957-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 01/14/2022] [Indexed: 12/28/2022] Open
Abstract
Background To retrospectively investigate the grey-scale, Doppler, contrast-enhanced and microvascular ultrasound of five patients with primary testicular lymphoma of our institute through review literature analysis. Methods From January to November 2020, five patients with primary testicular lymphoma confirmed by histology were preoperatively investigated with a standardized sonographic protocol including contrast-enhanced and microvascular ultrasound. Results Conventional ultrasound showed localized hypoechogenicity represented with solitary (2 of 5), multiple lesions (2 of 5), or entire testicular involvement (1 of 5). Increased blood flow appeared in color Doppler ultrasound with straight vascular sign (4 of 5). In contrast-enhanced ultrasound images confirmed this pattern (4 of 5) and presented hyper enhancement with enlarged range. On microvascular ultrasound imagings, all lesions were presented with straight and parallel course of intralesional vessels (5 of 5). Conclusions Here, we identified an increased vascularity with enlarged range on contrast-enhanced ultrasound along with a linear nonbranching pattern by vascular sign on microvascular ultrasonographic of testicular lymphoma.
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Conduit C, Tran B. Improving outcomes in germ cell cancers using miRNA. Ther Adv Med Oncol 2021; 13:17588359211027826. [PMID: 34262617 PMCID: PMC8252353 DOI: 10.1177/17588359211027826] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Owing to advances in treatment paradigms across the last five decades, testicular cancer is now eminently curable. However, current serum tumour and imaging biomarkers lack adequate sensitivity, specificity, and predictive value. Subsequently, their utility in detecting active malignancy and informing treatment decisions is minimal in a large proportion of men with testicular cancer. Micro-ribonucleic acids (miRNA), pertinently miR-371a-3p, offer a new tool, which based on early data, appears to fill many of the gaps that existing biomarkers leave. This paper reviews the evolution of the technology, potential limitations, and discusses the clinical relevance of miRNA as it moves towards the clinic.
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Affiliation(s)
- Ciara Conduit
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
| | - Ben Tran
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett St, Melbourne, VIC 8006, Australia
- Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
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11
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Tenuta M, Sesti F, Bonaventura I, Mazzotta P, Pofi R, Gianfrilli D, Pozza C. Use of contrast enhanced ultrasound in testicular diseases: A comprehensive review. Andrology 2021; 9:1369-1382. [PMID: 34043256 PMCID: PMC8640938 DOI: 10.1111/andr.13057] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Revised: 05/12/2021] [Accepted: 05/24/2021] [Indexed: 01/17/2023]
Abstract
Background Contrast‐enhanced ultrasound (CEUS) is a sonographic technique that increases the diagnostic accuracy of ultrasound and color Doppler ultrasound (CDUS) when studying testicular abnormalities. However, its role in clinical practice is still debatable because there are no accepted standards regarding how and when this technique should be used for patients with testicular disease. Objectives To perform a nonsystematic review of the current literature to highlight the strength and flaws of performing CEUS and to provide a critical overview of current research evidence on this topic. Materials and methods A thorough search of published peer‐reviewed studies in PubMed was performed using proper keywords. Results Strong enhancement of neoplastic lesions (both benign and malignant) during CEUS aids in differential diagnosis with non‐neoplastic lesions, which usually appears either nonenhanced or enhanced in a manner similar to that of the surrounding parenchyma. CEUS enhancement has a high predictive value in the identification of neoplastic lesions, whereas a similar or complete absence of enhancement may be interpreted as strong evidence of benignity, although there are exceptions. Literature on quantitative analysis is still scarce, though promising, particularly in distinguishing benign from malignant neoplasms. Furthermore, CEUS may be useful in many emergency situations, such as acute scrotum, blunt scrotal trauma, and focal infarction of the testis. Finally, CEUS can help increase the probability of sperm recovery in azoospermic males. Discussion and conclusion CEUS is a safe, easy‐to‐perform, and cost‐effective diagnostic tool that can provide a more accurate diagnosis in testicular lesions and acute scrotal disease. However, further studies with larger cohorts are required to refine the differential diagnosis between benign and malignant neoplasms. Finally, these preliminary results can instigate the development of innovative research on pre‐testicular sperm extraction to increase the chances of sperm recovery.
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Affiliation(s)
- Marta Tenuta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Paola Mazzotta
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | - Riccardo Pofi
- Department of Experimental Medicine, Sapienza University, Rome, Italy
| | | | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University, Rome, Italy
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12
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Soheili M, Keyvani H, Soheili M, Nasseri S. Human papilloma virus: A review study of epidemiology, carcinogenesis, diagnostic methods, and treatment of all HPV-related cancers. Med J Islam Repub Iran 2021; 35:65. [PMID: 34277502 PMCID: PMC8278030 DOI: 10.47176/mjiri.35.65] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Human papillomavirus (HPV) infection is considered as the most common viral sexually transmitted infection worldwide. This poses an increasingly interdisciplinary medical challenge. Since there is vast scattered information in databases about HPV and the correlated diseases, we decided to collect useful data so that the experts can get a more comprehensive view of HPV. Methods: In this article, HPV-associated diseases, prevalence, prevention, and new treatments are discussed. The retrieved articles reporting the latest data about the required information for our review were selected through searching in Web of Science, Scopus, Medline (PubMed), EMBASE, Cochrane Library, Ovid, and CINHAL with language limitations of English and German. Results: There are 2 groups of HPVs: (1) low-risk HPV types that can lead to genital warts, and (2) high-risk HPV types that are involved in HPV-associated oncogenesis. About 70% of all sexually active women are infected and most of these infections heal within many weeks or months. In the case of HPV-persistence, a risk of preneoplasia or carcinoma exists. These types of viruses are responsible for the existence of genitoanal, gastrointestinal, urinary tract, and head and neck tumors. There is still no definite successful treatment. The detection of HPV-related condylomata occurs macroscopically in women and men, and the diagnosis of the precursors of cervical carcinoma in women is possible by Pap smear. Conclusion: For extragenital manifestations, there is no structured early detection program. Meanwhile, studies on HPV vaccines confirm that they should be used for the primary prevention of HPV-dependent diseases. However, we need more research to find out the real advantages and disadvantages of vaccines.
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Affiliation(s)
- Maryam Soheili
- School of Kinesiology and Health Science, York University, Toronto, Canada
| | - Hossein Keyvani
- Department of Medical Virology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
- Gastrointestinal and Liver Disease Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Marzieh Soheili
- Faculty of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
- Human Revivification Society of Congress 60, Tehran, Iran
| | - Sherko Nasseri
- Cellular and Molecular Research Center, Research Institute for Health Development, Kurdistan University of Medical Sciences, Sanandaj, Iran
- Department of Molecular Medicine and Medical Genetics, Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
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13
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Lobo J, Leão R, Jerónimo C, Henrique R. Liquid Biopsies in the Clinical Management of Germ Cell Tumor Patients: State-of-the-Art and Future Directions. Int J Mol Sci 2021; 22:ijms22052654. [PMID: 33800799 PMCID: PMC7961393 DOI: 10.3390/ijms22052654] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 02/25/2021] [Accepted: 03/02/2021] [Indexed: 02/06/2023] Open
Abstract
Liquid biopsies constitute a minimally invasive means of managing cancer patients, entailing early diagnosis, follow-up and prediction of response to therapy. Their use in the germ cell tumor field is invaluable since diagnostic tissue biopsies (which are invasive) are often not performed, and therefore only a presumptive diagnosis can be made, confirmed upon examination of the surgical specimen. Herein, we provide an overall review of the current liquid biopsy-based biomarkers of this disease, including the classical, routinely used serum tumor markers—the promising microRNAs rapidly approaching the introduction into clinical practice—but also cell-free DNA markers (including DNA methylation) and circulating tumor cells. Finally, and importantly, we also explore novel strategies and challenges for liquid biopsy markers and methodologies, providing a critical view of the future directions for liquid biopsy tests in this field, highlighting gaps and unanswered questions.
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Affiliation(s)
- João Lobo
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
| | - Ricardo Leão
- Faculty of Medicine, University of Coimbra, Rua Larga, 3000-370 Coimbra, Portugal;
| | - Carmen Jerónimo
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
- Correspondence: (C.J.); (R.H.); Tel.: +351-22-225084000 (C.J. & R.H.); Fax: +351-22-5084199 (C.J. & R.H.)
| | - Rui Henrique
- Cancer Biology and Epigenetics Group, IPO Porto Research Center (GEBC CI-IPOP), Portuguese Oncology Institute of Porto (IPO Porto) & Porto Comprehensive Cancer Center (P.CCC), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal;
- Department of Pathology, Portuguese Oncology Institute of Porto (IPOP), R. Dr. António Bernardino de Almeida, 4200-072 Porto, Portugal
- Department of Pathology and Molecular Immunology, Institute of Biomedical Sciences Abel Salazar, University of Porto (ICBAS-UP), Rua Jorge Viterbo Ferreira 228, 4050-513 Porto, Portugal
- Correspondence: (C.J.); (R.H.); Tel.: +351-22-225084000 (C.J. & R.H.); Fax: +351-22-5084199 (C.J. & R.H.)
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14
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Brown D, Tsampoukas G, Popov EP, Aldin Z, Moussa M, Papatsoris A, Buchholz NNP. The role of radiological surveillance in the conservative management of incidental small testicular masses: A systematic review. Arab J Urol 2021; 19:179-185. [PMID: 34104494 PMCID: PMC8158180 DOI: 10.1080/2090598x.2021.1885949] [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: 11/15/2022] Open
Abstract
Objective: The increasing use of scrotal ultrasonography (US) for non-cancerous indications has led to greater detection of incidental, small testicular masses. Operative intervention is currently the mainstay of treatment for all testicular tumours; however, despite the low malignant potential of small, incidental masses, little is known about conservative management using radiological surveillance. Methods: A systematic review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted and studies meeting the inclusion criteria were reviewed for patient outcomes. Results: A total of 293 patients across six studies underwent radiological surveillance for an incidental small testicular mass. Infertility was the main indication for investigation and all studies used US as the surveillance modality. A total of 37 patients (12.6%) underwent surgical exploration during follow-up, with only 10 (3.4%) found to have malignant disease at histology. Conclusions: Radiological surveillance of incidental small testicular masses is safe when used for select patient groups due to the high probability of benign disease, although optimal patient selection criteria and a well-defined protocol are lacking. This approach could be considered in patients with incidental, impalpable testicular masses of ≤5 mm in diameter displaying no significant size increase or internal vascularity on US and with negative tumour markers, as the probability of malignancy in these patients is low.
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Affiliation(s)
- Dominic Brown
- Department of Urology, Broomfield Hospital, Chelmsford, UK
| | - Georgios Tsampoukas
- Department of Urology, Princess Alexandra Hospital Trust, Harlow, UK.,U-merge Ltd.† (Urology for Emerging Countries), London, UK
| | - Elenko Petkov Popov
- U-merge Ltd.† (Urology for Emerging Countries), London, UK.,Department of Urology, University Hospital of Sofia, Sofia, Bulgaria
| | - Zaid Aldin
- Department of Radiology, Princess Alexandra Hospital Trust, Harlow, UK
| | - Mohamad Moussa
- Department of Urology, Al-Zahraa Hospital, University Medical Center, Beirut, Lebanon
| | - Athanasios Papatsoris
- U-merge Ltd.† (Urology for Emerging Countries), London, UK.,2nd Department of Urology, University Hospital of Athens, Athens, Greece
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15
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Belge G, Grobelny F, Radtke A, Bodes J, Matthies C, Wülfing C, Dieckmann KP. Serum levels of microRNA-371a-3p are not elevated in testicular tumours of non-germ cell origin. J Cancer Res Clin Oncol 2020; 147:435-443. [PMID: 33200255 PMCID: PMC7817581 DOI: 10.1007/s00432-020-03429-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
Purpose Serum levels of microRNA-371a-3p (M371) have been shown to be a highly sensitive and specific biomarker for testicular germ cell tumours (TGCT). Little information exists on the expression of this marker in testicular neoplasms deriving from the gonadal stroma or other structures of the gonad. This study presents an expression analysis of the novel TGCT-biomarker M371 in a large cohort of testicular non-germ cell tumours. Methods The M371 expression was measured by quantitative real time PCR in serum of 99 patients with testicular tumours of non-germ cell origin, thereof 30 patients with malignant testicular lymphomas and 61 patients with gonadal stroma tumours such as Leydig cell tumours, Sertoli cell tumours and 8 cases with miscellaneous benign testicular tumours. Their M371 levels were compared to those of 20 patients with TGCT and to 37 tumour-free male controls. Results The median expression levels of benign testicular tumours and testicular lymphoma are close to zero, thus, identical with those of controls and significantly lower than those of TGCT. In summary, this study provides further evidence for the notion that M371 is exclusively expressed by germ cell tumours and not by testicular neoplasms of the non-germ cell subtypes. Conclusion Clinically, the test might be of value in preoperative characterization of benign testicular tumours eligible for conservative surgery.
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Affiliation(s)
- Gazanfer Belge
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | | | - Arlo Radtke
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Jacqueline Bodes
- Faculty of Biology and Chemistry, University of Bremen, Bremen, Germany
| | - Cord Matthies
- Department of Urology, Bundeswehrkrankenhaus Hamburg, Hamburg, Germany
| | - Christian Wülfing
- Department of Urology, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany
| | - Klaus-Peter Dieckmann
- Department of Urology, Asklepios Klinik Altona, Paul-Ehrlich-Str. 1, 22763, Hamburg, Germany.
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16
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Withey SJ, Horsfield CJ, Prezzi D. Multiparametric Ultrasound of Nonpalpable Focal Testicular Lesions. Semin Ultrasound CT MR 2020; 41:402-408. [DOI: 10.1053/j.sult.2020.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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17
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Schwarze V, Marschner C, Rübenthaler J, Negrão de Figueiredo G, Clevert DA. Overview of ultrasound applications for assessing scrotal disorders. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:1047-1056. [PMID: 31840876 DOI: 10.1002/jum.15197] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 11/20/2019] [Accepted: 11/29/2019] [Indexed: 06/10/2023]
Abstract
The scrotum may be affected by a plethora of different disorders such as infections, vasculopathies, trauma, and manifestations of primary and secondary malignant masses. In addition to the patient's medical history and clinical examination, ultrasound represents the imaging modality of choice to assess scrotal disorders. Time-consuming contrast-enhanced ultrasound and elastography can provide further information to distinguish between benign and malignant testicular mass lesions. The following invited Special Communication gives a comprehensive overview of differential diagnoses of the scrotum and their corresponding sonomorphologic correlates based on representative cases of the Interdisciplinary Ultrasound Center of the University Hospital Munich.
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Affiliation(s)
- Vincent Schwarze
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Constantin Marschner
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | - Johannes Rübenthaler
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
| | | | - Dirk-Andre Clevert
- Department of Radiology, Ludwig-Maximilians-University Munich, Grosshadern Campus, Munich, Germany
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18
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Application of miRNAs in the diagnosis and monitoring of testicular germ cell tumours. Nat Rev Urol 2020; 17:201-213. [PMID: 32157202 DOI: 10.1038/s41585-020-0296-x] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2020] [Indexed: 02/08/2023]
Abstract
Testicular germ cell tumours (TGCTs) are the most frequent cancer type in young men and originate from the common precursor germ cell neoplasia in situ (GCNIS). For decades, clinical management of patients with TGCT has relied on classic serum tumour markers: α-fetoprotein, human chorionic gonadotropin subunit-β and lactate dehydrogenase. In the past 10 years, microRNAs have been shown to outperform classic serum tumour markers in the diagnosis of primary tumours and in follow-up monitoring and prediction of relapse. miR-371a-3p is the most consistent marker and exhibits >90% diagnostic sensitivity and specificity in TGCT. However, miR-371a-3p cannot be used to diagnose GCNIS or mature teratoma. Future efforts must technically standardize the microRNA-based methods internationally and introduce miR-371a-3p as a molecular liquid biopsy-based marker for TGCTs in the clinic.
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19
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Honecker F, Aparicio J, Berney D, Beyer J, Bokemeyer C, Cathomas R, Clarke N, Cohn-Cedermark G, Daugaard G, Dieckmann KP, Fizazi K, Fosså S, Germa-Lluch JR, Giannatempo P, Gietema JA, Gillessen S, Haugnes HS, Heidenreich A, Hemminki K, Huddart R, Jewett MAS, Joly F, Lauritsen J, Lorch A, Necchi A, Nicolai N, Oing C, Oldenburg J, Ondruš D, Papachristofilou A, Powles T, Sohaib A, Ståhl O, Tandstad T, Toner G, Horwich A. ESMO Consensus Conference on testicular germ cell cancer: diagnosis, treatment and follow-up. Ann Oncol 2019; 29:1658-1686. [PMID: 30113631 DOI: 10.1093/annonc/mdy217] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The European Society for Medical Oncology (ESMO) consensus conference on testicular cancer was held on 3-5 November 2016 in Paris, France. The conference included a multidisciplinary panel of 36 leading experts in the diagnosis and treatment of testicular cancer (34 panel members attended the conference; an additional two panel members [CB and K-PD] participated in all preparatory work and subsequent manuscript development). The aim of the conference was to develop detailed recommendations on topics relating to testicular cancer that are not covered in detail in the current ESMO Clinical Practice Guidelines (CPGs) and where the available level of evidence is insufficient. The main topics identified for discussion related to: (1) diagnostic work-up and patient assessment; (2) stage I disease; (3) stage II-III disease; (4) post-chemotherapy surgery, salvage chemotherapy, salvage and desperation surgery and special topics; and (5) survivorship and follow-up schemes. The experts addressed questions relating to one of the five topics within five working groups. Relevant scientific literature was reviewed in advance. Recommendations were developed by the working groups and then presented to the entire panel. A consensus vote was obtained following whole-panel discussions, and the consensus recommendations were then further developed in post-meeting discussions in written form. This manuscript presents the results of the expert panel discussions, including the consensus recommendations and a summary of evidence supporting each recommendation. All participants approved the final manuscript.
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Affiliation(s)
- F Honecker
- Tumor and Breast Center ZeTuP, St. Gallen, Switzerland; Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany.
| | - J Aparicio
- Department of Medical Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - D Berney
- Department of Molecular Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - J Beyer
- Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - C Bokemeyer
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - R Cathomas
- Department of Oncology and Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - N Clarke
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - G Daugaard
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - K-P Dieckmann
- Department of Urology, Asklepios Klinik Altona, Hamburg, Germany
| | - K Fizazi
- Department of Cancer Medicine, Gustave Roussy, University of Paris Sud, Villejuif, France
| | - S Fosså
- Department of Oncology, Oslo University Hospital Radiumhospitalet, Oslo, Norway
| | - J R Germa-Lluch
- Department of Medical Oncology, Catalan Institute of Oncology (ICO), Barcelona University, Barcelona, Spain
| | - P Giannatempo
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - J A Gietema
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - S Gillessen
- Department of Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen; University of Bern, Bern, Switzerland
| | - H S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway; Institute of Clinical Medicine, UIT - The Arctic University, Tromsø, Norway
| | - A Heidenreich
- Department of Urology, Uro-Oncology, Robot-assisted and Specialised Urologic Surgery, University of Cologne, Cologne, Germany
| | - K Hemminki
- Department of Molecular Genetic Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - R Huddart
- Department of Radiotherapy and Imaging, The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
| | - M A S Jewett
- Departments of Surgery (Urology) and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, Canada
| | - F Joly
- Department of Urology-Gynaecology, Centre Francois Baclesse, Caen, France
| | - J Lauritsen
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - A Lorch
- Department of Urology, Genitourinary Medical Oncology, Heinrich-Heine University Hospital Düsseldorf, Düsseldorf, Germany
| | - A Necchi
- Department of Medical Oncology, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - N Nicolai
- Department of Surgery, Urology and Testis Surgery Unit, Fondazione IRCCS Istituto dei Tumori, Milan, Italy
| | - C Oing
- Department of Oncology, Hematology and Bone Marrow Transplantation with Section Pneumology, Hubertus Wald Tumorzentrum, University Medical Center, Hamburg, Germany
| | - J Oldenburg
- Department of Oncology, Akershus University Hospital, Lørenskog, Norway
| | - D Ondruš
- 1st Department of Oncology, St. Elisabeth Cancer Institute, Comenius University Faculty of Medicine, Bratislava, Slovak Republic
| | - A Papachristofilou
- Department of Radiation Oncology, University Hospital Basel, Basel, Switzerland
| | - T Powles
- Department of Medical Oncology, Barts Cancer Institute, Queen Mary University of London, London, UK
| | - A Sohaib
- Department of Radiology, Royal Marsden Hospital, Sutton, UK
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund University, Lund, Sweden
| | - T Tandstad
- The Cancer Clinic, St. Olavs Hospital, Trondheim, Norway
| | - G Toner
- Department of Medical Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Australia
| | - A Horwich
- The Institute of Cancer Research, Royal Marsden Hospital, Sutton, UK
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Abstract
Scrotal ultrasound with high-resolution transducers and additional display of vascularisation in colour-coded ultrasonography is the method of choice for the detection and characterisation of testicular tumors. Within the last decade, testicular ultrasonography has been further refined and improved by the possibilities of contrast-enhanced ultrasound (CEUS).CEUS may be especially helpful in the assessment of vascularisation disorders (e.g., incomplete torsion, segmental perfusion disorders, abscesses) or testicular foci remaining equivocal even after colour-coded ultrasonography.The basic idea in the application of CEUS in scrotal sonography is the possibility to differentiate between avascular, hypo- and hypervascular findings, with a lack of perfusion generally considered as a sign of benignity. Vice versa, detection of vascularisation speaks for neoplasia but not necessarily for malignity (e.g., Leydig cell tumors). CEUS is especially valuable in the correct classification of small (<1.5 cm) testicular foci.This review summarizes the present knowledge on indications, implications and limitations of the application of CEUS in testicular tumors.
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21
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Tullie STE, Quraishi MK, Karawita T, Anjarwalla S. Rare presentation of a testicular glomus tumour. BMJ Case Rep 2019; 12:12/11/e230935. [PMID: 31678923 DOI: 10.1136/bcr-2019-230935] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Glomus tumours are atypical in extracutaneous locations and very rarely located in reproductive organs. We present an unusual case of an incidentally discovered glomus tumour arising from the testis of a 47-year-old man. The testicular occurrence of this tumour type is not only exceptionally rare but also serves to highlight the debate regarding the optimal management of incidentally discovered small testicular lesions.
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Affiliation(s)
| | - Mohammed Kamil Quraishi
- Department of Urology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Thiwanka Karawita
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
| | - Salim Anjarwalla
- Department of Pathology, East Kent Hospitals University NHS Foundation Trust, Canterbury, Kent, UK
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22
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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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23
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Dieckmann KP, Radtke A, Geczi L, Matthies C, Anheuser P, Eckardt U, Sommer J, Zengerling F, Trenti E, Pichler R, Belz H, Zastrow S, Winter A, Melchior S, Hammel J, Kranz J, Bolten M, Krege S, Haben B, Loidl W, Ruf CG, Heinzelbecker J, Heidenreich A, Cremers JF, Oing C, Hermanns T, Fankhauser CD, Gillessen S, Reichegger H, Cathomas R, Pichler M, Hentrich M, Eredics K, Lorch A, Wülfing C, Peine S, Wosniok W, Bokemeyer C, Belge G. Serum Levels of MicroRNA-371a-3p (M371 Test) as a New Biomarker of Testicular Germ Cell Tumors: Results of a Prospective Multicentric Study. J Clin Oncol 2019; 37:1412-1423. [PMID: 30875280 PMCID: PMC6544462 DOI: 10.1200/jco.18.01480] [Citation(s) in RCA: 210] [Impact Index Per Article: 42.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Previous studies suggested that serum levels of microRNA (miR)-371a-3p (so-called M371 test) have a much higher sensitivity and specificity than the classic markers of testicular germ cell tumors (GCTs) and are applicable toward both seminoma and nonseminoma. We sought to confirm the usefulness of this test as a novel biomarker for GCT. PATIENTS AND METHODS In a prospective, multicentric study, serum samples of 616 patients with testicular GCTs and 258 male controls were examined for serum levels of miRNA-371a-3p (miR levels) by quantitative polymerase chain reaction. The GCT population encompassed 359 patients with seminoma and 257 with nonseminoma; 371 had clinical stage I disease, 201 had systemic disease, and 46 had relapses. Paired measurements before and after orchiectomy were performed in 424 patients; 118 with systemic disease had serial measurements during treatment. miR levels were compared with those of β-human chorionic gonadotropin, α-fetoprotein, and lactate dehydrogenase. RESULTS For the primary diagnosis of GCT, the M371 test showed a sensitivity of 90.1%, a specificity of 94.0%, an area under the curve of 0.966 upon receiver operating characteristic analysis, and a positive predictive value of 97.2%. α-Fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase had sensitivities of less than 50% in seminoma and slightly higher sensitivities in nonseminomas. miR levels were significantly associated with clinical stage, primary tumor size, and response to treatment. Relapses had elevated miR levels that subsequently dropped to normal upon remission. Teratoma did not express miR-371a-3p. CONCLUSION The M371 test outperforms the classic markers of GCT with both a sensitivity and a specificity greater than 90%. All histologic subgroups, except teratoma, express this marker. The test could be considered for clinical implementation after further validation.
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Affiliation(s)
- Klaus-Peter Dieckmann
- Asklepios Klinik Altona, Hamburg, Germany
- Albertinen-Krankenhaus Hamburg, Hamburg, Germany
| | | | - Lajos Geczi
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | | | | | | | | | | | - Stefan Zastrow
- Universitätsklinikum Carl Gustav Carus, Dresden, Germany
| | | | | | | | | | | | - Susanne Krege
- Klinikum Essen-Mitte Huyssenstiftung, Essen, Germany
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anja Lorch
- Urologische Universitätsklinik der Heinrich Heine Universität, Düsseldorf, Germany
| | | | - Sven Peine
- Universitätsklinikum Eppendorf, Hamburg, Germany
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Nicolai N, Biasoni D, Catanzaro MA, Colecchia M, Trama A, Hackl M, Eycken EV, Henau K, Dimitrova N, Sekerija M, Dušek L, Mägi M, Malila N, Leinonen M, Velten M, Troussard X, Bouvier V, Guizard AV, Bouvier AM, Arveux P, Maynadié M, Woronoff AS, Robaszkiewic M, Baldi I, Monnereau A, Tretarre B, Colonna M, Molinié F, Bara S, Schvartz C, Lapôtre-Ledoux B, Grosclaude P, Stabenow R, Luttmann S, Nennecke A, Engel J, Schubert-Fritschle G, Heidrich J, Holleczek B, Jónasson JG, Clough-Gorr K, Comber H, Mazzoleni G, Giacomin A, Sutera Sardo A, Barchielli A, Serraino D, De Angelis R, Mallone S, Tavilla A, Pierannunzio D, Rossi S, Santaquilani M, Knijn A, Pannozzo F, Gennaro V, Benfatto L, Ricci P, Autelitano M, Spagnoli G, Fusco M, Usala M, Vitale F, Michiara M, Tumino R, Mangone L, Falcini F, Ferretti S, Filiberti RA, Marani E, Iannelli A, Sensi F, Piffer S, Gentilini M, Madeddu A, Ziino A, Maspero S, Candela P, Stracci F, Tagliabue G, Rugge M, Trama A, Gatta G, Botta L, Capocaccia R, Pildava S, Smailyte G, Calleja N, Johannesen TB, Rachtan J, Góźdź S, Błaszczyk J, Kępska K, de Lacerda GF, Bento MJ, Miranda A, Diba CS, Almar E, Larrañaga N, de Munain AL, Torrella-Ramos A, Díaz García JM, Marcos-Gragera R, Sanchez MJ, Navarro C, Salmeron D, Moreno-Iribas C, Galceran J, Carulla M, Mousavi M, Bouchardy C, M. Ess S, Bordoni A, Konzelmann I, Rashbass J, Gavin A, Brewster DH, Huws DW, Visser O, Bielska-Lasota M, Primic-Zakelj M, Kunkler I, Benhamou E. Testicular germ-cell tumours and penile squamous cell carcinoma: Appropriate management makes the difference. Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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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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Abstract
Testicular cancer is the most common malignancy among men between 14 and 44 years of age, and its incidence has risen over the past two decades in Western countries. Both genetic and environmental factors contribute to the development of testicular cancer, for which cryptorchidism is the most common risk factor. Progress has been made in our understanding of the disease since the initial description of carcinoma in situ of the testis in 1972 (now referred to as germ cell neoplasia in situ), which has led to improved treatment options. The combination of surgery and cisplatin-based chemotherapy has resulted in a cure rate of >90% in patients with testicular cancer, although some patients become refractory to chemotherapy or have a late relapse; an improved understanding of the molecular determinants underlying tumour sensitivity and resistance may lead to the development of novel therapies for these patients. This Primer provides an overview of the biology, epidemiology, diagnosis and current treatment guidelines for testicular cancer, with a focus on germ cell tumours. We also outline areas for future research and what to expect in the next decade for testicular cancer.
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Parenti GC, Feletti F, Carnevale A, Uccelli L, Giganti M. Imaging of the scrotum: beyond sonography. Insights Imaging 2018; 9:137-148. [PMID: 29450854 PMCID: PMC5893488 DOI: 10.1007/s13244-017-0592-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 12/18/2017] [Accepted: 12/27/2017] [Indexed: 01/31/2023] Open
Abstract
The aim of this article is to describe the role of second-level imaging techniques after an initial ultrasonography evaluation in the assessment of scrotal diseases. While ultrasonography remains central as the primary imaging modality for the evaluation of pathologic conditions of the scrotum, the role of magnetic resonance imaging continues to evolve: it can actually be valuable as a problem-solving tool when sonographic findings are equivocal or inconclusive. Magnetic resonance imaging of the scrotum may provide accurate detection and characterization of scrotal diseases, well depicting the precise location of scrotal masses (intratesticular or extratesticular) and reliably characterizing benign conditions simulating neoplastic processes, thus preventing unnecessary radical surgery. Advanced magnetic resonance techniques, most of all diffusion weighted imaging and magnetic resonance spectroscopy, play in the meanwhile a more significant role in evaluating scrotal diseases. TEACHING POINTS • Multiparametric ultrasonography usually represents the initial imaging modality for approaching scrotal diseases. • MRI is well established as a problem-solving tool for inconclusive sonographic findings. • Advanced MRI techniques can be successfully applied in scrotal pathology assessment. • MRI is valuable in differentiating benign conditions from neoplastic processes. • CT plays a role in trauma assessment and cancer staging alongside PET/CT.
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Affiliation(s)
- Gian Carlo Parenti
- Department of Diagnostic Imaging of Romagna, Section of Radiology, Ospedale Civile Santa Maria delle Croci, 48100, Ravenna, Italy
| | - Francesco Feletti
- Department of Diagnostic Imaging of Romagna, Section of Radiology, Ospedale Civile Santa Maria delle Croci, 48100, Ravenna, Italy
| | - Aldo Carnevale
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy.
| | - Licia Uccelli
- Department of Morphology, Surgery and Experimental Medicine, Section of Nuclear Medicine, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
| | - Melchiore Giganti
- Department of Morphology, Surgery and Experimental Medicine, Section of Radiology, University of Ferrara, Via Ludovico Ariosto 35, 44121, Ferrara, Italy
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Scandura G, Verrill C, Protheroe A, Joseph J, Ansell W, Sahdev A, Shamash J, Berney DM. Incidentally detected testicular lesions <10 mm in diameter: can orchidectomy be avoided? BJU Int 2017; 121:575-582. [DOI: 10.1111/bju.14056] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Glenda Scandura
- Barts Cancer Institute; Queen Mary University of London; London UK
| | - Clare Verrill
- Nuffield Department of Surgical Sciences; University of Oxford; Oxford UK
| | - Andrew Protheroe
- Oxford Cancer and Haematology Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Johnson Joseph
- Oxford Cancer and Haematology Centre; Oxford University Hospitals NHS Foundation Trust; Oxford UK
| | - Wendy Ansell
- Department of Medical Oncology; Barts Health NHS Trust; London UK
| | - Anju Sahdev
- Department of Imaging; Barts Health NHS Trust; London UK
| | - Jonathan Shamash
- Department of Medical Oncology; Barts Health NHS Trust; London UK
| | - Daniel M. Berney
- Barts Cancer Institute; Queen Mary University of London; London UK
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Manganaro L, Saldari M, Pozza C, Vinci V, Gianfrilli D, Greco E, Franco G, Sergi ME, Scialpi M, Catalano C, Isidori AM. Dynamic contrast-enhanced and diffusion-weighted MR imaging in the characterisation of small, non-palpable solid testicular tumours. Eur Radiol 2017; 28:554-564. [DOI: 10.1007/s00330-017-5013-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 07/05/2017] [Accepted: 08/01/2017] [Indexed: 12/26/2022]
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Radtke A, Cremers JF, Kliesch S, Riek S, Junker K, Mohamed SA, Anheuser P, Belge G, Dieckmann KP. Can germ cell neoplasia in situ be diagnosed by measuring serum levels of microRNA371a-3p? J Cancer Res Clin Oncol 2017; 143:2383-2392. [PMID: 28819887 PMCID: PMC5640733 DOI: 10.1007/s00432-017-2490-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
Purpose Diagnosing germ cell neoplasia in situ (GCNis) can detect germ cell tumours (GCTs) at the pre-invasive stage. To date, testicular biopsy with the potential of surgical complications is the only way of safely diagnosing GCNis. Recently, microRNAs (miRs) 371-3, and miR 367 were shown to be valuable serum biomarkers of GCTs. We explored the usefulness of these candidate miRs as a marker for GCNis. Methods 27 patients with GCNis and no concomitant GCT were enrolled. All patients underwent measuring serum levels of miR-371a-3p and miR-367-3p before treatment, 11 had repeat measurement after treatment, 2 also had testicular vein blood examinations. Serum levels were measured by quantitative PCR. In addition, four orchiectomy specimens of patients with GCT were examined immunohistochemically and by in situ hybridization (ISH) with a probe specific for miR-371a-3p to look for the presence of this miR in GCNis cells. Results The median serum level of miR-371a-3p was significantly higher in patients with GCNis than in controls, miR-367 levels were not elevated. Overall, 14 patients (51.9%) had elevated serum levels of miR-371a-3p. The highest levels were found in patients with bilateral GCNis. Levels in testicular vein serum were elevated in both of the cases. After treatment, all elevated levels dropped to normal. In two orchiectomy specimens, miR-371a-3p was detected by ISH in GCNis cells. Conclusions Measuring miR-371a-3p serum levels can replace control biopsies after treatment of GCNis. In addition, the test can guide clinical decision making regarding the need of testicular biopsy in cases suspicious of GCNis.
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Affiliation(s)
- A Radtke
- Faculty of Biology and Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen, Germany.
| | - J-F Cremers
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Kliesch
- Department of Clinical and Surgical Andrology, Centre of Reproductive Medicine and Andrology, University of Muenster, Muenster, Germany
| | - S Riek
- Faculty of Biology and Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen, Germany
| | - K Junker
- Department of Pathology, Klinikum Bremen-Mitte, Bremen, Germany
| | - S A Mohamed
- Department of Cardiac and Thoracic Vascular Surgery, University of Luebeck, Luebeck, Germany
| | - P Anheuser
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
| | - G Belge
- Faculty of Biology and Chemistry, University of Bremen, Leobener Str. 2, 28359, Bremen, Germany
| | - K-P Dieckmann
- Department of Urology, Albertinen Krankenhaus, Hamburg, Germany
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Causes of Avascular Hypoechoic Testicular Lesions Detected at Scrotal Ultrasound: Can They Be Considered Benign? AJR Am J Roentgenol 2017. [PMID: 28639925 DOI: 10.2214/ajr.16.17333] [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] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purposes of this study were to determine the cause of avascular hypoechoic lesions detected at scrotal ultrasound and to assess usefulness of sonographic and clinical features in differentiating benign from malignant etiologic factors. MATERIALS AND METHODS This retrospective study included 58 patients with avascular hypoechoic lesions detected at testicular ultrasound. The sonographic features recorded were lesion size and margins and presence of peripheral vascularity and focal calcifications. Also recorded were patient age, symptoms, risk factors, lesion palpability, and levels of serum tumor markers. The reference standard was pathologic results or at least 2-year stability documented with serial follow-up ultrasound studies. Features associated with malignant, including burnt-out, lesions and benign lesions were examined by Fisher exact test, Wilcox-on rank sum test, and the generalized estimating equations method for multivariable models. RESULTS Sixty-three lesions were identified in 58 patients; 40 of the 63 (63.5%) were benign. Patients with malignant lesions had elevated serum tumor marker levels more often than patients who had benign lesions (26.1% versus 5.7%, p = 0.043). The clinical palpability of lesions and history of testicular cancer were not statistically significantly different between patients with malignant and those with benign lesions. Poorly defined margins of a lesion and focal calcification within the lesion were more often found in malignant lesions. Maximal size of a lesion and peripheral vascularity were not associated with either the benign or the malignant nature of a lesion. CONCLUSION Although most avascular hypoechoic testicular lesions are benign, a substantial proportion are malignant. The ultrasound characteristics of a lesion, the patient's clinical presentation, and serum tumor marker status may be useful in differentiating malignant from benign lesions.
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Auer T, De Zordo T, Dejaco C, Gruber L, Pichler R, Jaschke W, Dogra VS, Aigner F. Value of Multiparametric US in the Assessment of Intratesticular Lesions. Radiology 2017. [PMID: 28628420 DOI: 10.1148/radiol.2017161373] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Purpose To evaluate the diagnostic accuracy of multiparametric ultrasonography (US) consisting of gray-scale US, color Doppler US, strain elastography, and contrast agent-enhanced US in the assessment of intratesticular lesions. Materials and Methods Institutional review board approval was obtained for this retrospective study. From January 2012 to December 2015, 55 focal testicular lesions that were indeterminate on gray-scale US scans were further characterized with color Doppler US, strain elastography, and contrast-enhanced US. Strain elastography was performed to assess tissue elasticity, and hard lesions were defined as malignant. Color Doppler US and contrast-enhanced US were performed to determine the absence or presence of vascularization. Avascular lesions were defined as benign. Histopathologic results or follow-up examinations served as reference standards. Correct classification rate, sensitivity, specificity, and likelihood ratio were calculated. Results Of 55 testicular lesions, 43 (78.2%) were benign and 12 (21.8%) were malignant. Single-modality sensitivities and specificities were 66.7% and 88.4% for color Doppler US, 100% and 76.7% for contrast-enhanced US, and 100% and 72.1% for strain elastography, respectively. Among 12 malignant lesions, color Doppler US failed to demonstrate vascularization in four (33.3%) lesions, which were positive for cancer at contrast-enhanced US. By combining strain elastography and contrast-enhanced US, a sensitivity of 100% and specificity of 93.0% were achieved in differentiating benign and malignant focal testicular lesions. Positive likelihood ratio was 5.7 for color Doppler US, 4.3 for contrast-enhanced US, 3.6 for strain elastography, 14.3 for strain elastography combined with color Doppler US, and 14.3 for strain elastography combined with contrast-enhanced US. Conclusion Multiparametric US allows for a reliable differentiation of benign and malignant intratesticular lesions and can potentially be useful in deciding whether orchiectomy can be replaced with follow-up or less invasive organ-sparing strategies. © RSNA, 2017.
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Affiliation(s)
- Thomas Auer
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Tobias De Zordo
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Christian Dejaco
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Leonhard Gruber
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Renate Pichler
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Werner Jaschke
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Vikram S Dogra
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
| | - Friedrich Aigner
- From the Departments of Radiology (T.A., T.D.Z., L.G., W.J., F.A.) and Urology (R.P.), Medical University of Innsbruck, Innsbruck, Austria; Department of Radiology, Landeskrankenhaus Hall, Tirol, Austria (T.A.); Department of Radiology, Brixsana Private Clinic, Brixen, Italy (T.D.Z.); Department of Rheumatology, Medical University Graz, Graz, Austria (C.D.); and Department of Radiology, University of Rochester School of Medicine & Dentistry, Rochester, NY (V.S.D.)
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Wang H, Guan J, Lin J, Zhang Z, Li S, Guo Y, Cai H. Diffusion-Weighted and Magnetization Transfer Imaging in Testicular Spermatogenic Function Evaluation: Preliminary Results. J Magn Reson Imaging 2017; 47:186-190. [PMID: 28407330 DOI: 10.1002/jmri.25732] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/29/2017] [Indexed: 12/20/2022] Open
Affiliation(s)
- Huanjun Wang
- Department of Radiology; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong P.R. China
| | - Jian Guan
- Department of Radiology; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong P.R. China
| | - Jinhua Lin
- Ultrosounic Department; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong P.R. China
| | - Zhongwei Zhang
- Department of Biomedical Engineering, Cancer Biology, Radiology; Wake Forest School of Medicine; Winston-Salam North Carolina USA
| | - Shurong Li
- Department of Radiology; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong P.R. China
| | - Yan Guo
- Department of Radiology; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong P.R. China
| | - Huasong Cai
- Department of Radiology; First Affiliated Hospital of Sun Yat-Sen University; Guangzhou Guangdong P.R. China
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Rocher L, Glas L, Bellin MF, Ferlicot S, Izard V, Benoit G, Albiges L, Fizazi K, Correas JM. Burned-Out Testis Tumors in Asymptomatic Infertile Men: Multiparametric Sonography and MRI Findings. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:821-831. [PMID: 27914180 DOI: 10.7863/ultra.15.08037] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 05/25/2016] [Indexed: 06/06/2023]
Abstract
Multiparametric testicular ultrasound and magnetic resonance imaging (MRI) findings were analyzed in a series of 10 infertile asymptomatic men presenting with pathologically confirmed burned-out testicular tumors. Color/power Doppler ultrasound (CDUS), shear wave elastography (SWE), contrast-enhanced ultrasonography (CEUS), and MRI were performed on 10, 5, 6, and 7 patients, respectively. All lesions appeared as a hypoechoic and hypovascular nodular area at CDUS, SWE, CEUS CDUS, and CEUS (if performed). Shear wave elastography showed a stiffer nodular area compared with the surrounding/contralateral tissues (13 versus 2 kPa); MRI revealed a well-delineated nodular area in hypointense signal on T2, a high apparent diffusion coefficient value, and a lack of enhancement.
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Affiliation(s)
- Laurence Rocher
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
- Paris South Medical University, Le Kremlin Bicêtre, France
| | - Ludivine Glas
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
| | - Marie France Bellin
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France
- Paris South Medical University, Le Kremlin Bicêtre, France
| | - Sophie Ferlicot
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Pathology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Vincent Izard
- Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Gerard Benoit
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Urology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Laurence Albiges
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Oncology, the Gustave Roussy Institute, Villejuif, France
| | - Karim Fizazi
- Paris South Medical University, Le Kremlin Bicêtre, France
- Department of Oncology, the Gustave Roussy Institute, Villejuif, France
| | - Jean-Michel Correas
- Department of Adult Radiology, Necker University Hospital, Paris, France
- Paris Descartes University, Paris, France
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France
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Bojanic N, Bumbasirevic U, Bojanic G, Vukovic I, Milojevic B, Pekmezovic T. Testis sparing surgery for treatment of small testicular lesions: Is it feasible even in germ cell tumors? J Surg Oncol 2017; 115:287-290. [DOI: 10.1002/jso.24502] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2016] [Accepted: 10/21/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Nebojsa Bojanic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | | | | | - Ivan Vukovic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- Faculty of Medicine; University of Belgrade; Belgrade Serbia
| | | | - Tatjana Pekmezovic
- Institute of Epidemiology, Faculty of Medicine; University of Belgrade; Belgrade Serbia
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Pozza C, Gianfrilli D, Fattorini G, Giannetta E, Barbagallo F, Nicolai E, Cristini C, Di Pierro GB, Franco G, Lenzi A, Sidhu PS, Cantisani V, Isidori AM. Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non-palpable testicular lesions. Andrology 2016; 4:1193-1203. [PMID: 27565451 PMCID: PMC5108442 DOI: 10.1111/andr.12260] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/11/2016] [Accepted: 07/10/2016] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to evaluate prospectively the accuracy of qualitative and strain ratio elastography (SE) in the differential diagnosis of non‐palpable testicular lesions. The local review board approved the protocol and all patients gave their consent. One hundred and six patients with non‐palpable testicular lesions were consecutively enrolled. Baseline ultrasonography (US) and SE were correlated with clinical and histological features and ROC curves developed for diagnostic accuracy. The non‐palpable lesions were all ≤1.5 cm; 37/106 (34.9%) were malignant, 38 (35.9%) were benign, and 31 (29.2%) were non‐neoplastic. Independent risk factors for malignancy were as follows: size (OR 17.788; p = 0.002), microlithiasis (OR 17.673, p < 0.001), intralesional vascularization (OR 9.207, p = 0.006), and hypoechogenicity (OR, 11.509, p = 0.036). Baseline US had 89.2% sensitivity (95% CI 74.6–97.0) and 85.5% specificity (95% CI 75.0–92.8) in identifying malignancies, and 94.6% sensitivity (95% CI 86.9–98.5) and 87.1% specificity (95% CI 70.2–96.4) in discriminating neoplasms from non‐neoplastic lesions. An elasticity score (ES) of 3 out of 3 (ES3, maximum hardness) was recorded in 30/37 (81.1%) malignant lesions (p < 0.001). An intermediate score of 2 (ES2) was recorded in 19/38 (36.8%) benign neoplastic lesions and in 22/31 (71%) non‐neoplastic lesions (p = 0.005 and p = 0.001 vs. malignancies). None of the non‐neoplastic lesions scored ES3. Logistic regression analysis revealed a significant association between ES3 and malignancy (χ2 = 42.212, p < 0.001). ES1 and ES2 were predictors of benignity (p < 0.01). Overall, SE was 81.8% sensitive (95% CI 64.8–92.0) and 79.1% specific (95% CI 68.3–88.4) in identifying malignancies, and 58.6% sensitive (95% CI 46.7–69.9) and 100% specific (95% CI 88.8–100) in discriminating non‐neoplastic lesions. Strain ratio measurement did not improve the accuracy of qualitative elastography. Strain ratio measurement offers no improvement over elastographic qualitative assessment of testicular lesions; testicular SE may support conventional US in identifying non‐neoplastic lesions when findings are controversial, but its added value in clinical practice remains to be proven.
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Affiliation(s)
- C Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Fattorini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Barbagallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - C Cristini
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - G B Di Pierro
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - G Franco
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, England
| | - V Cantisani
- Department of Radiologic Science, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Schröder C, Lock G, Schmidt C, Löning T, Dieckmann KP. Real-Time Elastography and Contrast-Enhanced Ultrasonography in the Evaluation of Testicular Masses: A Comparative Prospective Study. ULTRASOUND IN MEDICINE & BIOLOGY 2016; 42:1807-1815. [PMID: 27181687 DOI: 10.1016/j.ultrasmedbio.2016.03.026] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 03/19/2016] [Accepted: 03/22/2016] [Indexed: 06/05/2023]
Abstract
This study investigates the usefulness of contrast-enhanced ultrasound (CEUS) and real-time elastography (RTE) for the characterization of testicular masses by comparing pre-operative ultrasound findings with post-operative histology. Sixty-seven patients with 68 sonographically detected testicular masses underwent B-mode, color-coded Doppler sonography (CCDS), CEUS and RTE according to defined criteria. For RTE, elasticity score (ES), difference of elasticity score (D-ES), strain ratio (SR) and size quotient (Qsize) were evaluated. Histopathologically, 54/68 testicular lesions were neoplastic (47 malignant, 7 benign). Descriptive statistics revealed the following results (neoplastic vs. non-neoplastic) for sensitivity, specificity, positive predictive value, negative predictive value and accuracy, respectively: B-mode, 100%, 43%, 87%, 100%, 88%; CCDS 81%, 86%, 96%, 55%, 82%; CEUS 93%, 85%, 96%, 73%, 91%; ES 98%, 25%, 85%, 75%, 85%; D-ES 98%, 50%, 90%, 83%, 89%; SR 90%, 45%, 86%, 56%, 81%; and Qsize 57%, 83%, 94%, 28%, 61%. B-mode with CCDS remains the standard for assessing testicular masses. In characterization of testicular lesions, CEUS clearly outperformed all other modalities. Our study does not support the routine use of RTE in testicular ultrasonography because of its low specificity.
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Affiliation(s)
- Claudia Schröder
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Guntram Lock
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany.
| | - Christa Schmidt
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Thomas Löning
- Institute of Pathology, Albertinen-Krankenhaus, Hamburg, Germany
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Lock G, Schmidt C, Schröder C, Löning T, Dieckmann KP. Straight Vessel Pattern and Rapid Filling Time: Characteristic Findings on Contrast-Enhanced Sonography of Testicular Lymphoma. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1593-1599. [PMID: 27335443 DOI: 10.7863/ultra.15.05049] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 10/14/2015] [Indexed: 06/06/2023]
Abstract
Six patients with 7 lesions that were histologically confirmed as primary testicular lymphoma were preoperatively investigated with a standardized sonographic protocol including contrast-enhanced sonography. Duplex and contrast-enhanced sonography showed marked hypervascularization in all 7 lesions. On contrast-enhanced sonography, the filling time of lymphomatous lesions was significantly shorter than the filling time of a size-matched sample of 10 patients with seminomas (P < .0001). The sonographic hallmarks of testicular lymphoma in our case series were as follows: (1) sharply demarcated homogeneous hypoechoic testicular lesions with marked hypervascularization; (2) a rapid (<7 seconds) filling time of contrast bubbles; and (3) a straight and parallel course of intralesional vessels on contrast-enhanced sonography.
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Affiliation(s)
- Guntram Lock
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Christa Schmidt
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Claudia Schröder
- Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg, Germany
| | - Thomas Löning
- Institute for Pathology, Albertinen-Krankenhaus, Hamburg, Germany
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Incidentally detected non-palpable testicular tumours in adults at scrotal ultrasound: impact of radiological findings on management Radiologic review and recommendations of the ESUR scrotal imaging subcommittee. Eur Radiol 2015; 26:2268-78. [DOI: 10.1007/s00330-015-4059-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/04/2015] [Accepted: 10/06/2015] [Indexed: 02/01/2023]
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MR Spectra of Normal Adult Testes and Variations with Age: Preliminary Observations. Eur Radiol 2015; 26:2261-7. [PMID: 26474986 DOI: 10.1007/s00330-015-4055-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 08/21/2015] [Accepted: 10/01/2015] [Indexed: 01/08/2023]
Abstract
OBJECTIVES The aim was to determine the proton MR (1H-MR) spectra of normal adult testes and variations with age. METHODS Forty-one MR spectra of normal testes, including 16 testes from men aged 20-39 years (group I) and 25 testes from men aged 40-69 years (group II), were analyzed. A single-voxel point-resolved spectroscopy sequence (PRESS), with TR/TE: 2000/25 ms was used. The volume of interest was placed to include the majority of normal testicular parenchyma. Association between normalized metabolite concentrations, defined as ratios of the calculated metabolite concentrations relative to creatine concentration, and age was assessed. RESULTS Quantified metabolites of the spectra were choline (Cho), creatine (Cr), myo-inositol (mI), scyllo-inositol, taurine, lactate, GLx compound, glucose, lipids, and macromolecules resonating at 0.9 ppm (LM09), around 20 ppm (LM20), and at 13 ppm (LM13). Most prominent peaks were Cho, Cr, mI, and lipids. A weak negative correlation between mI and age (P = 0.015) was observed. Higher normalized concentrations of Cho (P = 0.03), mI (P = 0.08), and LM13 (P = 0.05) were found in group I than in group II. CONCLUSIONS 1H-MR spectra of a normal adult testis showed several metabolite peaks. A decrease of levels of Cho, mI, and LM13 was observed with advancing age. KEY POINTS • Single-voxel PRESS MRS of a normal testis is feasible. • 1H-MR spectra of a normal testis showed several metabolite peaks. • Most prominent peaks were Cho, Cr, mI, and lipids. • A decrease of Cho, mI, and LM13 was seen with advancing age.
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Ghiraldi EM, Salami SS, Gilbert BR, Vira MA. Impalpable Testicular Seminoma Identified on Sonoelastography. J Med Ultrasound 2015. [DOI: 10.1016/j.jmu.2015.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Ates F, Malkoc E, Zor M, Demirer Z, Alp BF, Basal S, Guragac A, Yildirim I. Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant. Clin Genitourin Cancer 2015; 14:e49-53. [PMID: 26411594 DOI: 10.1016/j.clgc.2015.07.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Revised: 07/23/2015] [Accepted: 07/30/2015] [Indexed: 11/15/2022]
Abstract
UNLABELLED Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy. BACKGROUND We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant. PATIENTS AND METHODS Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy. RESULTS The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease. CONCLUSION The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.
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Affiliation(s)
- Ferhat Ates
- GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey
| | - Ercan Malkoc
- GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey
| | - Murat Zor
- GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey.
| | - Zafer Demirer
- Eskişehir Military Hospital, Urology Department, Istanbul, Turkey
| | | | - Seref Basal
- GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey
| | - Ali Guragac
- GMMA Medical Faculty, Urology Department, Ankara, Turkey
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Tsili AC, Ntorkou A, Baltogiannis D, Sylakos A, Stavrou S, Astrakas LG, Maliakas V, Sofikitis N, Argyropoulou MI. Magnetization transfer imaging of normal and abnormal testis: preliminary results. Eur Radiol 2015; 26:613-21. [DOI: 10.1007/s00330-015-3867-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Revised: 05/01/2015] [Accepted: 05/27/2015] [Indexed: 12/20/2022]
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Bojanic N, Bumbasirevic U, Vukovic I, Bojanic G, Milojevic B, Nale D, Durutovic O, Djordjevic D, Nikic P, Vuksanovic A, Tulic C, Micic S. Testis sparing surgery in the treatment of bilateral testicular germ cell tumors and solitary testicle tumors: A single institution experience. J Surg Oncol 2014; 111:226-30. [DOI: 10.1002/jso.23777] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 08/07/2014] [Indexed: 11/06/2022]
Affiliation(s)
- Nebojsa Bojanic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | | | - Ivan Vukovic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | | | | | - Djordje Nale
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | - Otas Durutovic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | | | - Predrag Nikic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
| | - Aleksandar Vuksanovic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | - Cane Tulic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
| | - Sava Micic
- Clinic of Urology; Clinical Center of Serbia; Belgrade Serbia
- School of Medicine; University of Belgrade; Belgrade Serbia
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Anheuser P, Kranz J, Will J, Dieckmann KP. [Complications associated with inguinal orchiectomy and scrotal orchiectomy]. Urologe A 2014; 53:676-82. [PMID: 24744108 DOI: 10.1007/s00120-014-3487-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Inguinal excision of testis is technically an elementary surgical procedure. According to the indication (e.g., malignant tumors, infarction, inflammation), an inguinal or alternatively a transcrotal approach is possible. Despite its straightforwardness, surgery of the scrotum includes remarkable risks and complications such as postoperative hemorrhage, hematoma formation, infections, and disturbances of wound healing followed by insufficient unfavorable cosmetic results. Nerve injury may be accompanied by temporary or persistent paresthesias which have been documented in our patients undergoing orchiectomy.
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Affiliation(s)
- P Anheuser
- Klinik für Urologie, Albertinen-Krankenhaus, Hogenfelder Straße 22, 22457, Hamburg, Deutschland,
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