Butruille C, Marcelli F, Ghoneim T, Lemaitre L, Puech P, Leroy X, Rigot J-M
Service d'andrologie, CHRU de Lille, hôpital Calmette, boulevard du Professeur-Jules-Leclercq, 59037 Lille, France.
Prog Urol. 2012 Jan;22(1):45-52. doi: 10.1016/j.purol.2011.08.030. Epub 2011 Oct 14.
Testicular parenchyma abnormalities and testis cancers are more frequent in infertile men, hence the guidelines recommending a systematic scrotal ultrasound.
A retrospective review of all patients treated with total or partial orchidectomy, from January, 2000 to July, 2010, for a testicular lesion discovered during an infertility evaluation work-up. Physical, examination data, type of surgery and pathological results were reported.
Forty-five patients were treated. The majority of tumors (80%) were non palpable, and incidentally discovered with scrotal ultrasonography. Eight cases were partial orchidectomies, and 37 cases were radical orchidectomies. A frozen section examination was performed in 13 cases, and led to two radical orchidectomies. Standard histological examination revealed 33 (73.3%) benign lesions (11 Leydig cell hyperplasias, 17 Leydig cell tumors, five Sertoli cell tumors) and 10 (22.2%) malignant lesions (nine seminomas and one teratoma). Ten patients had a Klinefelter syndrome, for whom all the lesions were benign.
The majority of non-palpable testicular lesions, discovered by ultrasonography in a population of infertile men were benign tumors. Conservative management in this context appears to be an option, to preserve the endocrine function and the fertility of these patients, while being ontologically safe.
不育男性中睾丸实质异常和睾丸癌更为常见，因此指南建议对阴囊进行系统超声检查。
回顾性分析2000年1月至2010年7月期间因不育评估检查中发现睾丸病变而接受全睾丸切除术或部分睾丸切除术的所有患者。报告了体格检查数据、手术类型和病理结果。
共治疗45例患者。大多数肿瘤（80%）触诊不到，是在阴囊超声检查时偶然发现的。8例行部分睾丸切除术，37例行根治性睾丸切除术。13例进行了冰冻切片检查，其中2例导致了根治性睾丸切除术。标准组织学检查显示33例（73.3%）为良性病变（11例莱迪希细胞增生、17例莱迪希细胞瘤、5例支持细胞瘤），10例（22.2%）为恶性病变（9例精原细胞瘤和1例畸胎瘤）。10例患者患有克兰费尔特综合征，其所有病变均为良性。
在不育男性人群中，通过超声检查发现的大多数触诊不到的睾丸病变为良性肿瘤。在这种情况下，保守治疗似乎是一种选择，既能保留这些患者的内分泌功能和生育能力，又能确保肿瘤学安全性。
