Detection of testicular ultrasonographic lesions in severe male infertility.
OBJECTIVE
We retrospectively assessed the number and histology of testicular lesions diagnosed clinically and by ultrasonography in a population of infertile men.


METHODS
From October 2000 to January 2003, 560 infertile men underwent physical examination, hormonal assessment (follicle-stimulating hormone, luteinizing hormone, testosterone) and scrotal ultrasonography. Eight men were diagnosed with focal testicular ultrasonographic lesions. In 4 cases there was a palpable lesion and in the other 4 cases the lesion was not palpable, diagnosed by ultrasonography (1 was cryptorchid). Only cases of lesions with clear-cut ultrasonographic edges and no history of recent genital infections were considered for explorative surgery through the groin. Microcalcifications were reported if present. The testicle was only preserved when frozen section examination revealed a benign lesion and the margins were negative.


RESULTS
Gynecomastia was not present in any patient. No microcalcifications were observed. Follicle-stimulating hormone was high in all patients (range 19.8 to 66.0 mUI/ml, mean 34.4). Luteinizing hormone levels were variable (range 1.32 to 28 mUI/ml, mean 12.3). Testosterone was normal in all cases (range 2.82 to 6.25 ng/ml, mean 4.2). Ultrasonographic features of the lesions were hypoechoic area (6 patients) and mixed hyper-hypoechoic area (2 patients). Histological outcomes of Leydig cell tumor (in 3 patients), focal Leydig cell hyperplasia (1 patient), fibrosis (1 patient), diffuse Leydig cell hyperplasia (1 patient), classic seminoma (1 patient) and embryonal carcinoma (in 1 patient) were observed.


CONCLUSIONS
Of 560 infertile patients 8 (1.4%) showed focal testicular lesions, 2 (0.4%) were diagnosed with germ cell tumors and 3 (0.5%) with interstitial cell neoplasms. The malignant tumors were both palpable and in 2 of 3 cases Leydig cell tumors were diagnosed only with ultrasonography.
Urology Unit, Department of Medicine, Surgery and Dental Sciences, University of Milan, San Paolo Hospital, Via Antonio di Rudini 8, 20142 Milan, Italy. luca.carmignani@unimi.it
Luca
L
Carmignani
Franco
F
Gadda
Mario
M
Mancini
Giacomo
G
Gazzano
Franco
F
Nerva
Francesco
F
Rocco
Giovanni Maria
GM
Colpi
D000328:Adult; D018237:Germinoma / Q000150:complications / Q000000981:diagnostic imaging; D006801:Humans; D006965:Hyperplasia; D007248:Infertility, Male / Q000000981:diagnostic imaging* / Q000209:etiology; D007984:Leydig Cell Tumor / Q000150:complications / Q000000981:diagnostic imaging; D007985:Leydig Cells / Q000473:pathology; D008297:Male; D013736:Testicular Neoplasms / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D013737:Testis / Q000000981:diagnostic imaging*; D014463:Ultrasonography