Elert Achim, Olbert Peter, Hegele Axel, Barth Peter, Hofmann Rainer, Heidenreich Axel
Department of Urology, Klinik für Urologie und Kinderurologie, Philipps-Universität Marburg, Baldingerstrasse, D-35033, Marburg, Germany.
Eur Urol. 2002 Mar;41(3):290-3. doi: 10.1016/s0302-2838(02)00004-0.
A total of 80-90% of all testicular masses are malignant germ cell tumors. Benign testicular lesions are recognized in approximately 10-20% enabling a testis-preserving surgery on the findings of frozen section examination (FSE). However, there are only sparse information with regard to the reliability of FSE in testicular tumors of uncertain dignity. Therefore, we retrospectively reviewed our experience concerning the reliability of FSE in primary testicular tumors by comparing each FSE result to the final diagnosis.
From 1974 to 2000, 354 patients were operated on a testicular tumor. During inguinal exploration and after clamping of the spermatic cord and appropriate dressing, a representative biopsy of the tumor was taken and sent for FSE. In case of malignancy radical orchiectomy was performed, in case of benign findings or in case of a germ cell tumor in a solitary testicle, the tumor was enucleated. Slides of FSE and the permanent sections were reviewed and compared with regard to the histological diagnosis and presence/absence of malignancy.
Based on FSE, 317 tumors (89.5%) were found to be malignant ((100 seminomas (38.5%), 217 nonseminomas (61.5%)) and 37 tumors (10.5%) were benign (17 epidermoid cysts, 14 Leydig cell tumors, two cystadenomas, two simple cysts, two hemangiomas). Comparing FSE and definitive diagnosis, FSE correctly identified all malignant and benign lesions. There was a failure rate of 10 and 8% to differentiate seminomatous from nonseminomatous tumors and vice versa based on FSE, which, however, was irrelevant for the surgical management. Complications of the enucleations (n = 37) were: testicular atrophy in three cases, testicular hematoma in three cases, orchitis/epididymitis in one case. Not a single case disclosed a local relapse after a mean follow-up of 105 (12-240) months.
Intraoperative FSE correctly identified all malignant and benign testicular masses including radical orchiectomy or organ-preserving surgery. Surgical management of testicular tumors based on FSE results is clinically practicable.
所有睾丸肿块中，80 - 90%为恶性生殖细胞肿瘤。约10 - 20%为良性睾丸病变，这使得在冷冻切片检查（FSE）结果的基础上能够进行保留睾丸的手术。然而，关于FSE在性质不确定的睾丸肿瘤中的可靠性，相关信息非常稀少。因此，我们通过将每个FSE结果与最终诊断进行比较，回顾性地分析了我们在原发性睾丸肿瘤中FSE可靠性方面的经验。
1974年至2000年期间，354例患者接受了睾丸肿瘤手术。在腹股沟探查过程中，夹闭精索并进行适当包扎后，取肿瘤的代表性活检组织送检FSE。若为恶性，则进行根治性睾丸切除术；若为良性或单睾丸中的生殖细胞肿瘤，则将肿瘤剜除。对FSE切片和永久切片进行复查，并就组织学诊断以及有无恶性情况进行比较。
基于FSE，发现317例肿瘤（89.5%）为恶性（100例精原细胞瘤（38.5%），217例非精原细胞瘤（61.5%）），37例肿瘤（10.5%）为良性（17例表皮样囊肿，14例Leydig细胞瘤，2例囊腺瘤，2例单纯囊肿，2例血管瘤）。比较FSE结果与最终诊断，FSE正确识别了所有恶性和良性病变。基于FSE区分精原细胞瘤与非精原细胞瘤的错误率分别为10%和8%，反之亦然，但这对手术管理并无影响。剜除术（n = 37）的并发症包括：3例睾丸萎缩，3例睾丸血肿，1例睾丸炎/附睾炎。平均随访105（12 - 240）个月后，无一例出现局部复发。
术中FSE正确识别了所有恶性和良性睾丸肿块，包括根治性睾丸切除术或保留器官手术。基于FSE结果进行睾丸肿瘤的手术管理在临床上是可行的。
