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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.

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), β-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.

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]

Testicular cancer is the most frequent type of cancer in the young adult men, it is relatively rare. Infertility is an important risk factor for testicular cancer, with a doubled risk of developing cancer compared to the general population. The standard treatment for testicular cancer is the radical orchiectomy, but partial orchiectomy or testicular sparing surgery (TSS) is indicated for small masses, as many experiences, have shown that many small masses found incidentally turn out to be benign., Case Presentation: The authors report the case of a patient presented for primary infertility, a clinical examination for left-sided gynecomastia without inflammatory signs. A testicular MRI revealed a 7 mm suspicious nodule in the posterior-inferior aspect of the right testicle, with contrast enhancement in the juxta-tumoral area corresponding to a heterogeneous area on ultrasound. Due to the lesion described on MRI, monorchidism, and azoospermia, a TSS combined with testicular biopsy and testicular sperm extraction was indicated., Clinical Discussion: The reference treatment for testicular cancer is the radical orchiectomy, but in some selected situations, partial orchiectomy or TSS is indicated, as many experiences have shown that many small masses found incidentally turn out to be benign., Conclusion: This case suggests that TSS or partial orchiectomy for small nonpalpable testicular masses in monorchidic patients can provide an excellent outcome for the patient., Competing Interests: None., (Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc.)

Objectives: Systematic review of the treatment of small testicular masses (STM) by testicular sparing surgery (TSS), including indications, surgical techniques and complications, as well as the correlation of the analysis of frozen sections (FSE) with the final tumor histology. As a secondary objective we report the initial experience of our center in TSS., Material and Methods: A systematic literature search of the Medline/PubMed database for studies published until June 30, 2019 with the following keywords: "testis sparing surgery", "conservative surgery", "partial orquiectomy" "testicular neoplasms", "testis tumour", "Sex cord tumor", "intraoperative ultrasonography", "enucleation", "excision" or "resection" without time limits, in English and Spanish, identifying 20 articles with a total of 204 TSS, being the series with the largest sample size of 28. In our service, 8 TSS were performed in 6 patients (two bilateral tumor) distributed between 2016-2019., Results: No randomized controlled trials comparing TSS with radical orchiectomy have been reported. The indications for TSS are controversial, especially for patients with normal contralateral testicles. Tumor size has been identified as an important predictor of malignant disease and although there is no approved cut-off point, STM ≤2 cm are the ones that can benefit most from TSS. The use of intraoperative ultrasound (IU) is essential for the location of STM, whether a macroscopic or microsurgical resection is being performed, helping to reduce the rate of complications of the procedure, described in < 6%. The FSE is key at the time of the TSS, discriminating between benign and malignant neoplasms, maintaining a good correlation with the final histology., Conclusions: TSS for STM allows greater preservation of healthy parenchyma, but should be performed only in selected cases and in experienced centers. The surgical technique is safe and viable, the use of the IU and the FSE of the lesion being essential to facilitate the surgical decision making.

Introduction: We present our experience with patients who had suspected testicular masses, managed by a frozen section assessment and testicular sparing surgery., Material and Methods: We performed a retrospective review of all patients over the last 5 years, who underwent a frozen section assessment and testicular sparing surgery for small testicular lesions. The frozen section assessment was compared with the final histology., Results: Twelve patients were identified. The mean age of patients was 40 years (22-58 years). The mean lesion size was 9.8 mm (3-18 mm). Presentations varied: a testicular lump was palpable in 7 patients and 3 patients were referred due to infertility with a subsequent ultrasound, which showed incidental testicular lesions. Two patients presented with testicular pain. Tumour marker levels were within the normal limits in all patients.The frozen section assessment correctly determined 10 out of 12 (83%) lesions, showing 1 (8%) lymphoma, 2 (17%) seminomas, 3 (25%) fibrosis, 3 (25%) low-grade Leydig cell tumours and 1 (8%) adenomatous tumour. The frozen section reported a benign epidermal cyst in 1 case, whilst the final histology showed a pre-pubertal type teratoma, a rare and low risk tumour. One patient (8%) had an indeterminate lesion, which proved to be a benign adenomatous tumour on final histology. All malignant cases were correctly identified.There was no malignancy in 9 out of 12 (75%) patients therefore they had testicular sparing surgery. Three patients had orchidectomy, two due to a seminoma and one due to an indeterminate lesion. One patient developed a postoperative haematoma requiring antibiotics but there were no other complications., Conclusions: Our findings demonstrate that partial orchidectomy with a frozen section assessment is useful in small testicular masses and testicular sparing surgery can be considered in order to prevent a radical orchidectomy in selected patients.

Background: Frozen section examination (FSE) for testicular masses is gaining popularity because of the possibility of performing testis-sparing surgery (TSS) on the basis of the FSE results. The aim of our study was to investigate the reliability of FSE in the diagnosis of testicular masses., Patients and Methods: From 1999 to 2016, 144 of 692 patients who underwent surgery in our tertiary center for testicular masses had FSE. The indications for FSE were: masses < 1 cm, nonpalpable, multiple, or with unusual presentation. Mean follow-up for patients was 25.5 months. The algorithm of surgery determined by FSE was: orchiectomy if malignant or nonconclusive pathology; TSS if benign or nontumor pathology. FSE data were analyzed retrospectively. Specificity and sensitivity of the method was calculated for benign, malignant, seminoma, and nonseminoma tumors., Results: Intraoperative FSE was conducted on 21% of candidates for surgery on testicular masses. The sensitivity and specificity of FSE were 93% and 98%, respectively, for malignant tumors, and 90% and 99%, respectively, for benign tumors. The κ agreement coefficient between FSE and final histopathology was statistically significant (0.76). TSS was performed in 57 (40%) patients, including 6 of 23 monorchid patients., Conclusion: FSE correlates well with final histopathological diagnosis of testicular masses. Thus, it reliably identifies patients who might benefit from TSS. FSE should be considered always in small, nonpalpable, multiple, or uncommonly presenting masses in solitary testis or both testes., (Copyright © 2017 Elsevier Inc. All rights reserved.)

Introduction: Radical orchiectomy (RO) is still considered the standard of care for malignant germ cell tumours, which represent the vast majority of the palpable testicular masses. In those patients diagnosed with small testicular masses (STMs), testis-sparing surgery (TSS) could be an alternative treatment to RO. The aim of this updated review is to evaluate the current indications for TSS, and discuss the oncological and functional results of patients who had undergone organ-sparing surgery for STMs., Evidence Acquisition: A non-systematic review of the Literature using the Medline database has been performed, including a free-text protocol using the terms "testis-sparing surgery", "testicular sparing surgery", "partial orchiectomy", "testis tumour", "sex cord tumour", and "testis function". Other significant studies cited in the reference lists of the selected papers were also evaluated., Evidence Synthesis: No randomized controlled trials comparing TSS with radical orchiectomy have been reported yet. In those patients with normal contra-lateral testis, the use of TSS is still controversial. In selected cases of gonadal masses < 2 cm, TSS seems to be a safe and feasible treatment option. Frozen section examination allows us to discriminate between benign and malignant neoplasms during TSS. Intermediate and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in the literature., Conclusions: TSS is an effective treatment for STMs in selected patients, limiting the unnecessary surgical over-treatments, without compromising the oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety., (Copyright © 2013 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.)

Background: The aim of this study was to evaluate the incidence of malignancy in small testicular masses (STMs) treated with testis-sparing surgery (TSS) with intraoperative frozen section analysis and to assess the safety of this surgical procedure., Patients and Methods: From January 2009 to January 2013, 15 consecutive patients underwent TSS for STMs in a third-referral academic institution. Every patient was preoperatively evaluated with clinical examination and scrotal ultrasonography (US) performed by the same radiologist. Tumor markers were assessed in all cases. All the procedures were performed through inguinal access; the small mass was identified by straight palpation of the testis or with intraoperative ultrasonography (IUS). Frozen-section examination (FSE) was performed in all patients in association with multiple biopsies of the surrounding tissue. Follow-up was carried out in all patients with an ultrasonographic exploration at 6 and 12 months., Results: Preoperative tumor markers were normal in all patients. The mean operative time was 90 ± 31 minutes. The warm ischemia time was 18 ± 3 minutes. The mean size on US was 9.5 ± 4.4 mm. FSE results were confirmed by the final pathologic analysis in 14 patients. At final pathologic analysis, 6 patients (40%) were found not to have tumors, another 7 patients (46.7%) had benign neoplasms, and malignant tumor was found in only 2 patients (13.3%). There was no disease recurrence after a mean follow-up of 19.2 ± 11.5 months., Conclusion: Our experience shows that TSS performed for STMs may represent a safe procedure with optimal results in terms of functional and oncologic end points., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Malignant germ cell tumours represent the vast majority of palpable testicular masses, and radical orchiectomy is still considered the standard-of-care. Testis-sparing surgery (TSS) could be an alternative to radical orchiectomy in patients diagnosed with small testicular masses (STMs). The aim of this article was to review the current indications and the oncological and functional outcomes of TSS when performed for STMs., Materials and Methods: We performed a non-systematic review of literature using the Medline database, including a free-text protocol using the terms "testis sparing surgery", "partial orchiectomy", "testis tumour" and "sex cord tumour". Only the articles reporting data on organ-sparing surgery for testicular neoplasms were evaluated., Results: No randomized controlled trials comparing TSS with radical orchiectomy have been reported. Indications for TSS are controversial, especially for patients with normal contra-lateral testis. For testicular masses of less then 2 cm, TSS seems to be the best treatment option. Frozen-section examination is an essential assessment at the time of TSS, and allows for discrimination of benign from malignant neoplasms. Intermediate- and long-term follow-up results showed no significant risk of local and distant recurrences in the main series reported in literature., Conclusion: According to currently available data, TSS is a safe and effective treatment for STMs in selected patients, and bypasses surgical overtreatment, without compromising oncological and functional outcomes. Further studies are needed in order to confirm the oncological safety of this procedure.