Universität zu Köln

Paffenholz, Pia, Held, Linn, Loosen, Sven H., Pfister, David and Heidenreich, Axel (2018). Testis Sparing Surgery for Benign Testicular Masses: Diagnostics and Therapeutic Approaches. J. Urol., 200 (2). S. 353 - 360. NEW YORK: ELSEVIER SCIENCE INC. ISSN 1527-3792

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Abstract

Purpose: 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. Materials and Methods: We performed a retrospective, single center analysis of the records of 522 patients diagnosed with primary testicular masses of unknown malignant potential. Results: 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(3), range 0.1 to 2.1 vs 15, range 4.5-39.9, p <= 0.001). At a cutoff of 2.8 cm(3) 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 mg/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. Conclusions: Nongerm cell tumors should be considered when small testicular masses have a volume of less than 2.8 cm(3) and there are hormone disorders or normal tumor markers. Immediate orchiectomy should be avoided, favoring testis sparing surgery.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Paffenholz, Pia UNSPECIFIED UNSPECIFIED UNSPECIFIED Held, Linn UNSPECIFIED UNSPECIFIED UNSPECIFIED Loosen, Sven H. UNSPECIFIED UNSPECIFIED UNSPECIFIED Pfister, David UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-179115
DOI:	10.1016/j.juro.2018.03.007
Journal or Publication Title:	J. Urol.
Volume:	200
Number:	2
Page Range:	S. 353 - 360
Date:	2018
Publisher:	ELSEVIER SCIENCE INC
Place of Publication:	NEW YORK
ISSN:	1527-3792
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language FROZEN-SECTION EXAMINATION; ORGAN-PRESERVING SURGERY; LEYDIG-CELL TUMOR; TERM-FOLLOW-UP; RADICAL ORCHIECTOMY; SINGLE-CENTER; MANAGEMENT; ULTRASOUND; EXPERIENCE Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/17911