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Published on: March 31, 2023
Management of nonpalpable incidental testicular masses
Timothy M Powell1, Thomas H Tarter
1Division of Urology, Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794, USA.
Purpose:
We report on 4 patients who presented with nonpalpable testicular masses discovered on scrotal ultrasound, and offer treatment recommendations based on our experience and a review of the literature.
Materials And Methods:
Four patients underwent intraoperative ultrasound guided localization and excisional biopsy of nonpalpable testicular parenchymal masses. Radical orchiectomy was performed in 2 patients because of testicular cancer. Patient age, clinical presentation, ultrasound results, frozen section and permanent pathology results are reported.
Results:
During a 3-year period 1,040 scrotal ultrasounds were performed for indications other than retroperitoneal mass at a single institution, and nonpalpable testicular parenchymal masses were discovered in 4 patients with an age range of 22 to 31 years. Testis mass size ranged from 5 to 6 mm in maximum diameter and serum tumor markers were negative in all patients. Frozen section pathology indicated benign lesions in all patients and permanent pathology revealed seminoma in 2 of the patients who underwent delayed radical orchiectomy. Permanent pathology of orchiectomy specimens did not reveal residual invasive tumor.
Conclusions:
Intraoperative ultrasound guided localization and excisional biopsy is a reasonable treatment option for patients with nonpalpable incidental testicular masses. Excisional biopsy with margins that show normal testicular tissue is essential in testis sparing surgery and patients must be cautioned that final pathology may indicate the need for delayed radical orchiectomy.
Insights
Intraoperative ultrasound-guided excisional biopsy is a viable option for nonpalpable testicular masses. Final pathology may necessitate delayed radical orchiectomy, even with initial benign frozen section results.
Area of Science:
- Urology
- Diagnostic Imaging
- Surgical Oncology
Background:
- Nonpalpable testicular masses are increasingly detected via scrotal ultrasound.
- Distinguishing benign from malignant lesions preoperatively can be challenging.
Purpose of the Study:
- To evaluate the efficacy of intraoperative ultrasound-guided excisional biopsy for nonpalpable testicular masses.
- To provide treatment recommendations based on clinical experience and literature review.
Main Methods:
- Four patients with nonpalpable testicular masses underwent ultrasound-guided localization and excisional biopsy.
- Radical orchiectomy was performed in two cases based on intraoperative findings and pathology.
- Patient data including age, presentation, imaging, and pathology were analyzed.
Main Results:
- Nonpalpable masses (5-6 mm) were found in 4 patients (age 22-31) during 1,040 scrotal ultrasounds.
- Serum tumor markers were negative; frozen section indicated benign lesions in all cases.
- Permanent pathology revealed seminoma in 2 patients requiring delayed radical orchiectomy.
Conclusions:
- Intraoperative ultrasound-guided excisional biopsy is a reasonable approach for incidental nonpalpable testicular masses.
- Achieving clear margins is crucial for testis-sparing surgery.
- Patients must be informed of the potential need for delayed radical orchiectomy based on final pathology.
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