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Objectives: To report the management outcomes of men with ≤20‐mm small testicular masses (STMs) and to identify clinical and histopathological factors associated with malignancy. Patients and methods: A retrospective analysis of men managed at a single centre between January 2010 and December 2020 with a STM ≤20 mm in size was performed. Results: Overall, 307 men with a median (interquartile range [IQR]) age of 36 (30–44) years were included. Of these, 161 (52.4%), 82 (26.7%), 62 (20.2%) and 2 men (0.7%) underwent surveillance with interval ultrasonography (USS), primary excisional testicular biopsy (TBx) or primary radical orchidectomy (RO), or were discharged, respectively. The median (IQR) surveillance duration was 6 (3–18) months. The majority of men who underwent surveillance had lesions <5 mm (59.0%) and no lesion vascularity (67.1%) on USS. Thirty‐three (20.5%) men undergoing surveillance had a TBx based on changes on interval USS or patient choice; seven (21.2%) were found to be malignant. The overall rate of malignancy in the surveillance cohort was 4.3%. The majority of men who underwent primary RO had lesions ≥10 mm (85.5%) and the presence of vascularity (61.7%) on USS. Nineteen men (23.2%) who underwent primary TBx (median lesion size 6 mm) had a malignancy confirmed on biopsy and underwent RO. A total of 88 men (28.7%) underwent RO, and malignancy was confirmed in 73 (83.0%) of them. The overall malignancy rate in the whole STM cohort was 23.8%. Malignant RO specimens had significantly larger lesion sizes (median [IQR] 11 [8–15] mm, vs benign: median [IQR] 8 [5–10] mm; P = 0.04). Conclusions: Small testicular masses can be stratified and managed based on lesion size and USS features. The overall malignancy rate in men with an STM was 23.8% (4.3% in the surveillance group). Surveillance should be considered in lesions <10 mm in size, with a TBx or frozen‐section examination offered prior to RO in order to preserve testicular function. [ABSTRACT FROM AUTHOR]

Objective: In our study, we retrospectively analyzed the pathology results of radical orchiectomy operations performed in our clinic and to correlate preoperative color Doppler ultrasonography (CDUSG) findings with small-testicular masses (SmTM) with negative serum tumor markers (STM). Materials and Methods: Male patients (n=98) who underwent radical orchiectomy between January 2010 and January 2021 to treat intratesticular solid lesions that were detected via CDUSG were evaluated retrospectively. All patients were evaluated in terms of age, atrophic testis, echogenicity, size of tumoral lesions, testicular palpability, preoperative STM and postoperative pathology results. Results: Expression of at least one STM was elevated in 58 (59.2%) patients preoperatively. STM elevation continued to occur in 25 (25.5%) patients postoperatively; furthermore, 81 (82.7%) patients presented with malignant pathology. The mean age of patients was 39.47±15.20 years, whereas the mean age of patients with benign pathology was higher than patients with malignant pathology (p=0.008). The mean size of malignant lesions was significantly greater than that of benign lesions (5.4 vs 3.5 cm; p=0.033). Statistically elevated STM, lower age, heterogeneity in CDUSG, and large lesion size were found as parameters predicting malignancy. Although lesions in 9 (45%) of 20 STM-negative patients with a lesion smaller than 3 cm were benign, benign pathology was detected in 6 (75%) of 8 STM-negative patients with a lesion smaller than 1.5 cm. Conclusion: CDUSG plays an important role in detecting small non-palpable masses. Especially in STM-negative patients with a SmTM, CDUSG can reasonably guide the decision-making phase although it cannot provide definitive diagnosis. Radical orchiectomy, which is the traditional approach for all solid testicular lesions, leads to unnecessary treatment in patients with benign lesions, so testicular-sparing surgery should be preferred in STM-negative non-palpable SmTMs because the risk of cancer is low. [ABSTRACT FROM AUTHOR]

Purpose: One of the main issues in testicular germ cell tumors (TGCTs) management is to reduce the necessary amount of treatment to achieve cure. Excess treatment burden may arise from late diagnosis of the primary as well as from false positive or negative staging results. Correct imaging is of paramount importance for successful management of TGCT. The aim of this review is to point out the current state of the art as well as innovative developments in TGCT imaging on the basis of three common challenging clinical situations. Methods: A selective literature search was performed in PubMed, Medline as well as in recent conference proceedings. Results: Regarding small testicular lesions, recent studies using elastography, contrast-enhanced ultrasound or magnetic resonance imaging (MRI) showed promising data for differentiation between benign and malignant histology. For borderline enlarged lymph nodes FDG-PET-CT performance is unsatisfactory, promising new techniques as lymphotropic nanoparticle-enhanced MRI is the subject of research in this field. Regarding the assessment of postchemotherapeutic residual masses, the use of conventional computerized tomography (CT) together with serum tumor markers is still the standard of care. To avoid overtreatment in this setting, new imaging modalities like diffusion-weighted MRI and radiomics are currently under investigation. For follow-up of clinical stage I TGCTs, the use of MRI is non-inferior to CT while omitting radiation exposure. Conclusion: Further efforts should be made to refine imaging for TGCT patients, which is of high relevance for the guidance of treatment decisions as well as the associated treatment burdens and oncological outcomes. [ABSTRACT FROM AUTHOR]

Objective: We aimed to determine the predictive value of additional parameters for differentiating benign-malign tumors and to identify optimal patients for partial orchiectomy in unilateral, small (=2 cm) testicular masses. Methods: The data of 31 patients who underwent radical orchiectomy between January 2010 and December 2017 due to unilateral and small testicular masses were retrospectively analyzed. Demographic data, histopathological tumor types, serum tumor markers, neutrophil/lymphocyte ratio (NLR), monocyte/lymphocyte ratio (MLR), platelet/lymphocyte ratio (PLR), mean platelet volume (MPV), red cell distribution width (RDW), the presence of testicular dysgenesis syndrome (TDS) and its components, postoperative follow-up outcomes were recorded. Patients were divided into two groups as benign and malignant. Results: There was no significant difference between groups in terms of AFP (p=0.116), ß-hCG (p=0.205), LDH (p=0.606), MPV (p=0.087) and RDW (p=0.266); while MLR (p=0.001), NLR (p=0.036) and PLR (p=0.001) were significantly higher in malignant group. The presences of testicular microlithiasis (p=0.719), undescended testis (p=0.254), hypospadias (p=0.645), atrophic testis (p=0.409) were not different between groups; while the rate of disorders of semen parameters (p=0.043) and presence of TDS (p=0.043) were significantly higher in malignant cases. In multivariate analysis, MLR and PLR were found as predictive factors for benign-malign distinction of small testicular masses. Conclusion: In the patients in whom preoperative malignancy suspicion could not be excluded, we think that PLR, MLR, NLR, disorders of semen parameters and presence of TDS may have high predictive value for benign-malign distinction. Partial orchiectomy may be recommended in patients with suspicion of benign lesions according to these parameters. [ABSTRACT FROM AUTHOR]