Horstman W G, Haluszka M M, Burkhard T K
Department of Radiology, Naval Medical Center San Diego, California 92134-5000.
J Urol. 1994 May;151(5):1263-5. doi: 10.1016/s0022-5347(17)35227-8.
Incidental nonpalpable testicular masses were discovered in 9 patients during approximately 1,600 scrotal ultrasound examinations done for other indications. Of the 9 lesions 7 (78%) were benign (4 Leydig cell tumors, 2 Sertoli cell tumors and 1 interstitial fibrosis) and 2 (22%) were malignant (1 teratocarcinoma and 1 seminoma). Five lesions (55%) were less than 1 cm (4 benign and 1 malignant), while 4 (45%) were 1 to 2 cm (3 benign and 1 malignant). Seven lesions (78%) were hypoechoic, 1 (11%) was hyperechoic and 1 (11%) was cystic. We conclude that incidentally discovered nonpalpable lesions are usually benign. Management should include inguinal exploration with frozen section diagnosis. The testis can be spared if the lesion is benign. Ultrasound followup should be used only if there is a strong clinical suspicion of a nonneoplastic lesion, such as recent trauma or infection. It is suggested that nonpalpable tumors discovered in patients with metastatic germ cell tumor should be treated as malignant.
在大约1600次因其他指征进行的阴囊超声检查中，9例患者发现了偶然出现的不可触及的睾丸肿块。9个病灶中，7个（78%）为良性（4个莱迪希细胞瘤、2个支持细胞瘤和1个间质纤维化），2个（22%）为恶性（1个畸胎癌和1个精原细胞瘤）。5个病灶（55%）小于1厘米（4个良性和1个恶性），而4个（45%）为1至2厘米（3个良性和1个恶性）。7个病灶（78%）为低回声，1个（11%）为高回声，1个（11%）为囊性。我们得出结论，偶然发现的不可触及病灶通常是良性的。处理应包括腹股沟探查及冰冻切片诊断。如果病灶是良性的，可以保留睾丸。仅当临床上强烈怀疑为非肿瘤性病灶（如近期外伤或感染）时，才应进行超声随访。建议在转移性生殖细胞肿瘤患者中发现的不可触及肿瘤应按恶性处理。
