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.

[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. _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.

[3]   A. Heidenreich and M. Angerer-Shpilenya, “Organ-Preserving Surgery for Testicular Tumours,” BJU International, Vol. 109, No. 3, 2012, pp. 474-490. 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.

[5]   Z. Csapo, C. Bornhof and J. Giedl, “Impalpable Testicular Tumors Diagnosed by Scrotal Ultrasonography,” Urology, Vol. 32, No. 6, 1988, pp. 549-552. (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. (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.

[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.

[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.

[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.

[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.

[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.

[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. 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.

[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.

[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. 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.

[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. 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.

[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.

[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.