Prognostic parameters in adult impalpable ultrasonographic lesions of the testicle.
OBJECTIVE
Through an analysis of individual published data we assessed whether prognostic criteria exist for adult impalpable testicular sonographic lesions.


METHODS
We performed a bibliographic search on PubMed, MEDLINE, EMBASE online databases from 1990 to May 2004 using search words such as sonographic lesions of the testicle, impalpable tumors of the testicle and impalpable testicular lesions. Six articles were found that presented a description of the histological characteristics, patient age, lesion dimensions, presence of cryptorchidism and association with tumors in other parts of the body. A multivariate analysis was performed comparing the characteristics that appeared more interesting from a univariate analysis.


RESULTS
The characteristics of the 48 impalpable sonographic lesions were examined. Histologically 15 of the lesions were Leydig cell tumors (31%), 12 (25%) seminomas, 7 (14.5%) nonseminomatous germ cell tumors, 2 (4.5%) Sertoli cell tumors, 12 (25%) benign forms (fibrosis, infarct, lipoma, mesothelial hyperplasia, adenomatoid tumor). The average age was 37.5, average dimension was 10.11 mm. The lesions were hypoechoic in 85% of the cases. Of the patients 31% were infertile. Multivariate analysis showed that histological data were correlated with lesion dimensions and presence of infertility. Dimension was particularly related to germ cell tumors (for dimensions between 16 and 32 mm relative risk ratio [RRR] = 13.97, p=0.0449). Infertility proved significant in defining stromal tumors (RRR = 9,681, p=0.022)


CONCLUSIONS
Although with the limits of a retrospective study consisting in an analysis of individual data, interesting correlations between malignant pathologies and the initial characteristics of impalpable sonographic lesions were revealed. In particular an interesting correlation was found between the dimensions of the lesion and the malignant pathology and between Leydig cell tumor and infertility.
Carmignani
Luca
L
From the Department of Medicine and Surgery, Urology Unit, University of Milan, IRCCS Ospedale Maggiore di Milano, Italy. luca.carmignani@unimi.it
Morabito
Alberto
A
Gadda
Franco
F
Bozzini
Giorgio
G
Rocco
Francesco
F
Colpi
Giovanni Maria
GM
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D005500:Follow-Up Studies; D006801:Humans; D007248:Infertility, Male / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D016015:Logistic Models; D008297:Male; D008432:Mathematical Computing; D008875:Middle Aged; D015999:Multivariate Analysis; D009373:Neoplasms, Germ Cell and Embryonal / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology; D010173:Palpation; D011379:Prognosis; D012189:Retrospective Studies; D012306:Risk; D013223:Statistics as Topic; D015996:Survival Rate; D013647:Task Performance and Analysis; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000401:mortality / Q000473:pathology; D013737:Testis / Q000000981:diagnostic imaging; D014463:Ultrasonography