OJU  Vol.3 No.7 , November 2013
Nonpalpable Testicular Masses—Should We Be Worried?
ABSTRACT

Objective: To report our experience of a contemporary series of patients who underwent radical orchidectomy for non-palpable testicular masses, in order to comment on their malignant potential and identify any factors predictive of a malignant outcome. Materials and Methods: We reviewed the case-notes of patients who underwent radical inguinal orchidectomy over a 22-month period between January 2010 and October 2011. Results: A total of 71 patients were analysed, with a mean (range) age of 45 years (17 - 82). Overall, 41 (57.7%) orchidectomies were malignant and 30 (42.3%) were benign. There were 20 (28%) non-palpable testicular masses found incidentally on ultrasound, and of these 40% were malignant and 60% were benign. In total 6 of these non-palpable lesions were <1 cm in size, and of these 66.6% were malignant and 33.3% were benign. The majority of tumours were in patients under the age of 50, but there was no correlation between the lesion size and the risk of a malignant outcome. Conclusion: In view of the significant rate of malignancy in non-palpable testicular masses we recommend surgical intervention over surveillance alone. However, as the majority of these lesions may eventually turn out to be benign, we suggest that testis-sparing surgery is the optimal approach, and should be performed in centres where the required radiological, histopathological, and surgical expertise exists.


Cite this paper
H. Abboudi, S. Malde, A. Mchaourab, B. Eddy and N. Shrotri, "Nonpalpable Testicular Masses—Should We Be Worried?," Open Journal of Urology, Vol. 3 No. 7, 2013, pp. 281-286. doi: 10.4236/oju.2013.37053.
References
[1]   P. Albers, W. Albrecht, F. Algaba, C. Bokemeyer, G. Cohn-Cedermark, K. Fizazi, et al., European Association of Urology Guidelines on Testicular Cancer, 2012. http://www.uroweb.org/fileadmin/tx _eauguidelines/2012/Full/Testis_Cancer.pdf

[2]   J. P. Richie, “Detection and Treatment of Testicular Cancer,” CA: A Cancer Journal for Clinicians, Vol. 43, No. 3, 1993, pp. 151-175. http://dx.doi.org/10.3322/canjclin.43.3.151

[3]   A. Heidenreich and M. Angerer-Shpilenya, “Organ-Preserving Surgery for Testicular Tumours,” BJU International, Vol. 109, No. 3, 2012, pp. 474-490. http://dx.doi.org/10.1111/j.1464-410X.2011. 10913.x

[4]   G. Giannarini, K. P. Dieckmann, P. Albers, A. Heidenreich and G. Pizzocaro, “Organ-Sparing Surgery for Adult Testicular Tumours: A Systematic Review of the Literature,” European Urology, Vol. 57, No. 5, 2010, pp. 780-790. http://dx.doi.org/10.1016/j.eururo.2010.01.014

[5]   Z. Csapo, C. Bornhof and J. Giedl, “Impalpable Testicular Tumors Diagnosed by Scrotal Ultrasonography,” Urology, Vol. 32, No. 6, 1988, pp. 549-552. http://dx.doi.org/10.1016/S0090-4295 (98)90043-7

[6]   M. B. Buckspan, P. G. Klotz, M. Goldfinger, S. Stoll and B. Fernandes, “Intraoperative Ultrasound in the Conservative Resection of Testicular Neoplasms,” Journal of Urology, Vol. 141, No. 2, 1989, pp. 326-327.

[7]   D. Corrie, E. J. Mueller and I. M. Thompson, “Management of Ultrasonically Detected Nonpalpable Testis Masses,” Urology, Vol. 38, No. 5, 1991, pp. 429-431. http://dx.doi.org/10.1016/0090-4295 (91)80231-U

[8]   W. G. Horstman, M. M. Haluszka and T. K. Burkhard, “Management of Testicular Masses Incidentally Discovered by Ultrasound,” Journal of Urology, Vol. 151, No. 5, 1994, pp. 1263-1265.

[9]   C. V. Comiter, C. J. Benson, C. C. Capelouto, P. Kantoff, L. Shulman and J. P. Richie, “Nonpalpable Intratesticular Masses Detected Sonographically,” Journal of Urology, Vol. 154, No. 4, 1995, pp. 1367-1369. http://dx.doi.org/10.1016/S0022-5347(01)66865-4

[10]   C. V. Hopps and M. Goldstein, “Ultrasound Guided Needle Localization and Microsurgical Exploration for Incidental Nonpalpable Testicular Tumors,” Journal of Urology, Vol. 168, No. 3, 2002, pp. 1084-1087. http://dx.doi.org/10.1016/S0022-5347(05)64580-6

[11]   L. Carmignani, F. Gadd, G. Gazzano, F. Nerva, M. Mancini, M. Ferruti, et al., “High Incidence of Benign Testicular Neoplasms Diagnosed by Ultrasound,” Journal of Urology, Vol. 170, No. 5, 2003, pp. 1783-1786. http://dx.doi.org/10.1097/01.ju.0000092066.01699.90

[12]   T. Muller, C. Gozzi, T. Akkad, L. Pallwein, G. Bartsch and H. Steiner, “Management of Incidental Impalpable Intratesticular Masses of < or = 5 mm in Diameter,” BJU International, Vol. 98, No. 5, 2006, pp. 1001-1004. http://dx.doi.org/10.1111/j.1464-410X.2006.06485.x

[13]   T. M. Powell and T. H. Tarter, “Management of Nonpalpable Incidental Testicular Masses,” Journal of Urology, Vol. 176, No. 1, 2006, pp. 96-98. http://dx.doi.org/10.1016/S0022-5347(06)00496-4

[14]   A. Avci, B. Erol, C. Eken and Y. Ozgok, “Nine Cases of Nonpalpable Testicular Mass: An Incidental Finding in a Large Scale Ultrasonography Survey,” International Journal of Urology, Vol. 15, No. 9, 2008, pp. 833-836. http://dx.doi.org/10.1111/j.1442-2042.2008.02120.x

[15]   Y. R. Sheynkin, T. Sukkarieh, M. Lipke, H. L. Cohen and D. A. Schulsinger, “Management of Nonpalpable Testicular Tumors,” Urology, Vol. 63, No. 6, 2004, pp. 1163-1167. http://dx.doi.org/ 10.1016/j.urology.2003.12.054

[16]   X. Leroy, J. M. Rigot, S. Aubert, C. Ballereau and B. Gosselin, “Value of Frozen Section Examination for the Management of Nonpalpable Incidental Testicular Tumors,” European Urology, Vol. 44, No. 4, 2003, pp. 458-460. http://dx.doi.org/10.1016/S0302-2838(03)00316-6

[17]   L. Carmignani, A. Morabito, F. Gadda, G. Bozzini, F. Rocco and G. M. Colpi, “Prognostic Parameters in Adult Impalpable Ultrasonographic Lesions of the Testicle,” Journal of Urology, Vol. 174, No. 3, 2005, pp. 1035-1038. http://dx.doi.org/10.1097/01.ju.0000170236.01129.d4

[18]   R. G. Hindley, A. Chandra, A. Saunders and T. S. O’Brien, “Impalpable Testis Cancer,” BJU International, Vol. 92, No. 6, 2003, pp. 572-574. http://dx.doi.org/10.1046/j.1464-410X.2003. 04432.x

[19]   R. Segal, H. Luka, L. H. Klotz, A. Eady, N. Bestic and M. Johnston, “Surveillance Programs for Early Stage NonSeminomatous Testicular Cancer: A Practice Guideline,” The Canadian Journal of Urology, Vol. 8, No. 1, 2001, pp. 1184-1192.

[20]   A. C. Tsili, M. I. Argyropoulou, D. Giannakis, N. Sofikitis and K. Tsampoulas, “MRI in the Characterization and Local Staging of Testicular Neoplasms,” American Journal of Roentgenology, Vol. 194, No. 3, 2010, pp. 682-689. http://dx.doi.org/10.2214/AJR.09.3256

[21]   R. Tokuc, W. Sakr, J. E. Pontes and G. P. Haas, “Accuracy of Frozen Section Examination of Testicular Tumors,” Urology, Vol. 40, No. 6, 1992, pp. 512-516. http://dx.doi.org/10.1016/0090-4295(92) 90405-L

[22]   A. Elert, P. Olbert, A. Hegele, P. Barth, R. Hofmann and A. Heidenreich, “Accuracy of Frozen Section Examination of Testicular Tumors of Uncertain Origin,” European Urology, Vol. 41, No. 3, 2002, pp. 290-293. http://dx.doi.org/10.1016/S0302-2838(02)00004-0

[23]   Y. Ehrlich, M. Konichezky, O. Yossepowitch and J. Baniel, “Multifocality in Testicular Germ Cell Tumors,” Journal of Urology, Vol. 181, 2009, pp. 1114-1119. http://dx.doi.org/10.1016/j.juro.2008.11.025

[24]   A. Heidenreich, P. Albers and S. Krege, “Management of Bilateral Testicular Germ Cell Tumours—Experience of the German Testicular Cancer Study Group (GTCSG),” European Urology Supplements, Vol. 5, No. 2, 2006, p. 97. http://dx.doi.org/10.1016/S1569-9056(06)60305-9

 
 
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