Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.
Internal Medicine and Digestive Physiopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italia.
Andrology. 2022 Oct;10(7):1387-1397. doi: 10.1111/andr.13233. Epub 2022 Aug 9.
The widespread use of ultrasonography has led to an increased number of incidentally detected small non-palpable lesions, with Leydig cell tumours representing the majority of them.
The ultrasonography, real-time elastography and contrast-enhanced ultrasonography features of a large series of non-palpable testicular lesions were evaluated, focusing on the differences between Leydig cell tumours and other testicular masses.
Of the 4679 testicular ultrasonography examinations performed at the Authors' Institution between January 2009 and December 2018, 78 patients (1.7%) were incidentally diagnosed with at least one non-palpable lesion and were enrolled. Thirteen patients (16.6%) declined surgery and were thus excluded. The remaining 65 underwent surgical resection with frozen section analysis. The conventional ultrasonography, colour Doppler, real-time elastography and contrast-enhanced ultrasonography were performed by a radiologist having more than 10 years of experience. Demographic and clinical data were collected.
Leydig cell tumours were detected in 32 patients, being the most frequent benign tumours (49.2%); of the non-Leydig cell tumours, 25 patients had malignant tumours, five non-neoplastic lesions and three other benign tumours. The Leydig cell tumour group had mostly infertility problems whereas the non-Leydig cell tumour group frequently experienced pain (p < 0.001). Leydig cell tumours were all hypoechoic (32/32, 100%; p = 0.002), more frequently presented with well-defined margins compared to non-Leydig cell tumours (30/32, 93.8% vs. 19/33, 57.6%; p = 0.001) and tended to be smaller than non-Leydig cell tumours (5.3 mm [standard deviation 2.7 mm] vs. 10.6 mm [standard deviation 3.8 mm], respectively; p < 0.001). The vascular pattern characterised by the rapid wash-in followed by the delayed wash-out observed during contrast-enhanced ultrasonography was significantly associated with the Leydig cell tumour histological diagnosis, even at multivariate analysis (odds ratio 480.5, p < 0.001), and yielded a high diagnostic accuracy (area under the receiver operating characteristic curve 0.954, 95% confidence interval 0.903-1).
Contrast-enhanced ultrasonography demonstrated high diagnostic accuracy in identifying benign testicular lesions, such as Leydig cell tumours; they are the most common non-palpable tumours detected in infertile men and may benefit from enucleation.
超声检查的广泛应用导致偶然发现的小而不可触及的病变数量增加，其中莱迪希细胞瘤占多数。
评估大量不可触及睾丸病变的超声、实时弹性成像和对比增强超声特征，重点比较莱迪希细胞瘤与其他睾丸肿块之间的差异。
在作者机构 2009 年 1 月至 2018 年 12 月进行的 4679 例睾丸超声检查中，78 例（1.7%）患者偶然诊断出至少存在一个不可触及的病变，并被纳入研究。13 例患者（16.6%）拒绝手术，因此被排除。其余 65 例患者接受了手术切除和冷冻切片分析。由一位具有 10 年以上经验的放射科医生进行常规超声、彩色多普勒、实时弹性成像和对比增强超声检查。收集人口统计学和临床数据。
32 例患者被诊断为莱迪希细胞瘤，是最常见的良性肿瘤（49.2%）；非莱迪希细胞瘤组中，25 例为恶性肿瘤，5 例为非肿瘤性病变，3 例为其他良性肿瘤。莱迪希细胞瘤组主要存在不孕问题，而非莱迪希细胞瘤组则常伴有疼痛（p<0.001）。莱迪希细胞瘤均为低回声（32/32，100%；p=0.002），与非莱迪希细胞瘤相比，更常表现为边界清晰（30/32，93.8%比 19/33，57.6%；p=0.001），且体积较小（5.3mm[标准差 2.7mm]比 10.6mm[标准差 3.8mm]；p<0.001）。对比增强超声检查中观察到的快速注入后延迟洗脱的血管模式与莱迪希细胞瘤的组织学诊断显著相关，即使在多变量分析中也是如此（优势比 480.5，p<0.001），并具有较高的诊断准确性（受试者工作特征曲线下面积 0.954，95%置信区间 0.903-1）。
对比增强超声检查在识别良性睾丸病变（如莱迪希细胞瘤）方面具有较高的诊断准确性；它们是在不孕男性中最常发现的不可触及肿瘤，可能受益于肿瘤切除术。
