Testicular Nodules Suspected for Malignancy. Does the Pathologist Make the Difference for Organ-Sparing Surgery?

To evaluate the factors that influence decision-making after frozen section examination (FSE) when a urologist sends a surgical specimen of a testicular nodule to a pathologist.

We retrieved, from surgical and pathological files of our center from 2008 to 2014, the clinical information of 15 patients who underwent an explorative inguinal testicular surgery for an intratesticular nodule suspected for malignancy and managed with intention of testicular-sparing surgery. We identify the factors that influenced the correlation between outcome of the FSE and final histopathological report.

Mean diameter of the testicular nodules was 8.37 mm. Very small lesions (< 5 mm) were detected in 4 cases (27%), with definitive diagnosis of seminoma in 2 of those (50%). At clinical evaluation 2 nodules were palpable but not malignant at definitive diagnosis. Overall, at definitive histopathological nodule report, a pathologist diagnosed 5 Leydig cell tumors, 4 seminomas, 1 adenomatoid tumor, 1 Sertoli cell tumor, 1 malignant teratoma, and a hemorragic infiltrate in 3 cases. FSE on testicular biopsy reported intratesticular neoplasia only in all cases of definitive diagnosis of seminoma. We observed a concordance between nodule FSE and definitive pathologic report in 11 cases (73%) and in 87% of ancillary testicular biopsies. Discordance was observed in cases lacking the availability of a dedicated pathologist.

In cases of small testicular nodule FSE may aid the surgery decision and avoid overtreatment. The close collaboration between urologist and a dedicated pathologist is very useful in reducing diagnostic and therapeutic errors.