Department of Urology, Hartford Hospital, Hartford, Connecticut.
Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
J Urol. 2018 Feb;199(2):481-486. doi: 10.1016/j.juro.2017.08.004. Epub 2017 Aug 5.
We report the safety of surveillance of small testicular masses incidentally discovered during evaluation of male infertility.
We retrospectively reviewed a prospectively collected database to identify patients with male infertility found to have incidental small testicular masses (hypoechoic lesions less than 10 mm) on scrotal ultrasound. The men were offered close surveillance with interval imaging and office followup. Patient and imaging characteristics were collected to compare the surveillance and surgical groups with additional comparisons between benign and malignant pathologies to elucidate predictors of underlying malignancy.
Of 4,088 men in whom scrotal ultrasound was completed for male infertility evaluation 120 (2.9%) were found to have a subcentimeter testicular mass. Average followup was 1.30 years (range 0.1 to 16.9). A total of 18 men (15%) proceeded to extirpative surgery while 102 remained on surveillance at last followup. In those with at least 1 month of followup the mean lesion growth rate was -0.01 mm per year. Reasons for surgery included testicular exploration for infertility, mass growth, positive tumor markers, history of testis cancer, concerning imaging characteristics and patient choice. Six of the 18 men who underwent surgery were found to have malignancy, which was seminoma in all. All malignant lesions were greater than 5 mm on initial imaging and demonstrated vascularity, although size and vascularity were not significantly different from those of benign lesions on final pathology findings. No patients demonstrated advanced or recurrent disease.
Small testicular masses are not uncommon, especially in the infertile male population. Most of these masses do not show significant growth during long-term evaluation and can be safely surveilled with close followup.
我们报告了在男性不育评估过程中偶然发现的小睾丸肿块的监测安全性。
我们回顾性地审查了一个前瞻性收集的数据库，以确定在阴囊超声检查中偶然发现小睾丸肿块（回声低于 10 毫米的低回声病变）的男性不育患者。这些男性被提供了密切的监测，包括间隔成像和办公室随访。收集患者和影像学特征，以比较监测和手术组，并对良性和恶性病变进行额外比较，以阐明潜在恶性肿瘤的预测因素。
在 4088 名接受阴囊超声检查以评估男性不育的男性中，有 120 名（2.9%）发现有亚厘米睾丸肿块。平均随访时间为 1.30 年（范围 0.1 至 16.9）。共有 18 名男性（15%）进行了切除术，而 102 名男性在最后一次随访时仍在接受监测。在至少有 1 个月随访的患者中，平均病变生长速度为每年-0.01 毫米。手术的原因包括为不育进行睾丸探查、肿块生长、肿瘤标志物阳性、睾丸癌病史、影像学特征和患者选择。在接受手术的 18 名男性中，有 6 名被发现患有恶性肿瘤，均为精原细胞瘤。所有恶性病变在初始影像学上均大于 5 毫米，并表现出血管生成，尽管最终病理学检查结果显示大小和血管生成与良性病变无显著差异。没有患者出现晚期或复发性疾病。
小睾丸肿块并不少见，尤其是在不育的男性人群中。这些肿块中的大多数在长期评估中不会出现明显的生长，可以通过密切随访安全地进行监测。
