Management of incidental impalpable intratesticular masses of < or = 5 mm in diameter.
OBJECTIVE
To gain more insight into the histology of small incidental intratesticular lesions and evaluate the need for surgical management, as exploratory surgery is the only way to exclude malignancy in testicular tumours.


METHODS
Between September 2000 and April 2005, incidental intratesticular masses of < or = 5 mm in diameter were found in 20 men undergoing scrotal ultrasonography for reasons other than suspected testicular tumour. After staging, an organ-sparing approach including frozen-section analysis was used to obtain histological data.


RESULTS
The mean diameter of the detected tumour masses was 3.5 mm, and the mean (range) age of the patients was 36.4 (26-58) years. Four men (20%) had orchidectomy because the tumours were found to be malignant; the resected specimens yielded multifocal testicular intraepithelial neoplasia (TIN) in all patients and additional seminomatous tumour cells elsewhere in the testis in one. Frozen-section results were false-negative in one patient and he had orchidectomy after having established the definitive histological diagnosis. The 16 patients with benign lesions were correctly diagnosed and their testicles were not removed.


CONCLUSIONS
Advanced and innovative ultrasonography technology allows the detection of increasingly small testicular masses. In the present series, most incidental intratesticular lesions were benign. In patients with malignant lesions, multifocal TIN and/or distant seminomatous foci were present despite the tumour being small. Therefore, it is essential to perform exploratory surgery as it is the only way to obtain accurate histological findings, thus providing oncological efficacy and precluding removal of a testicle bearing a benign lesion.
Müller
Tilko
T
Department of Urology and Radiology, Medical University Innsbruck, Austria.
Gozzi
Christian
C
Akkad
Thomas
T
Pallwein
Leo
L
Bartsch
Georg
G
Steiner
Hannes
H
D000328:Adult; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy / Q000379:methods*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D013736:Testicular Neoplasms / Q000473:pathology / Q000601:surgery*