Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany.
Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany.
J Urol. 2018 Aug;200(2):353-360. doi: 10.1016/j.juro.2018.03.007. Epub 2018 Mar 9.
Small benign testicular masses are often misinterpreted as germ cell tumors and immediate inguinal orchiectomy is performed. We analyzed the diagnostic and therapeutic workup of testicular masses to improve preoperative stratification algorithms.
We performed a retrospective, single center analysis of the records of 522 patients diagnosed with primary testicular masses of unknown malignant potential.
A total of 28 patients (5%) showed a primary benign tumor after resection, including Leydig cell tumors in 9 (32%), epidermoid cysts in 9 (32%), adenomatoid tumors in 8 (29%) and Sertoli cell tumors in 2 (7%). The median volume of benign tumors was significantly less than that of malignant tumors (0.75 cm, range 0.1 to 2.1 vs 15, range 4.5-39.9, p ≤0.001). At a cutoff of 2.8 cm tumor volume most accurately differentiated between benign and malignant disease, and it was a predictor of malignancy with 83% sensitivity and 89% specificity (OR 1.389, 95% CI 1.035-1.864, p = 0.029). Symptom duration in patients with benign tumors was significantly longer (365 days, range 25.5 to 365 vs 20, range 7 to 42, p ≤0.001). Also, tumor markers were unaltered in benign lesions. In patients with benign tumors significantly more fertility disorders or cryptorchidism were found (p ≤0.001) as well as a tendency toward lower testosterone (3.9 μg/l, range 0.9 to 4.9 vs 5.3, range 3.5 to 6.8, p = 0.084). Testis sparing surgery was performed in 22 of all patients (79%) with benign tumors. There was no case of relapse during followup.
Nongerm cell tumors should be considered when small testicular masses have a volume of less than 2.8 cm and there are hormone disorders or normal tumor markers. Immediate orchiectomy should be avoided, favoring testis sparing surgery.
小的良性睾丸肿块常被误诊为生殖细胞肿瘤，并立即进行腹股沟睾丸切除术。我们分析了睾丸肿块的诊断和治疗方法，以改善术前分层算法。
我们对 522 例诊断为原发性睾丸肿块（恶性潜能未知）的患者进行了回顾性、单中心分析。
共有 28 例（5%）患者在切除后显示为原发性良性肿瘤，其中包括 9 例（32%）Leydig 细胞瘤、9 例（32%）表皮样囊肿、8 例（29%）腺瘤和 2 例（7%）Sertoli 细胞瘤。良性肿瘤的中位数体积明显小于恶性肿瘤（0.75cm，范围 0.1-2.1 与 15cm，范围 4.5-39.9，p ≤0.001）。在肿瘤体积为 2.8cm 的截点处，最能准确地区分良性和恶性疾病，并且是恶性肿瘤的预测因子，其敏感性为 83%，特异性为 89%（OR 1.389，95%CI 1.035-1.864，p = 0.029）。良性肿瘤患者的症状持续时间明显较长（365 天，范围 25.5-365 与 20 天，范围 7-42，p ≤0.001）。此外，良性病变中的肿瘤标志物也没有改变。在良性肿瘤患者中，发现明显更多的生育障碍或隐睾症（p ≤0.001）以及倾向于较低的睾酮（3.9μg/l，范围 0.9-4.9 与 5.3μg/l，范围 3.5-6.8，p = 0.084）。在所有 22 例良性肿瘤患者中均进行了保留睾丸手术。在随访期间没有复发的病例。
当睾丸肿块体积小于 2.8cm 且存在激素紊乱或正常肿瘤标志物时，应考虑非生殖细胞瘤。应避免立即进行睾丸切除术，而应优先选择保留睾丸手术。
