title: Ultrasonography underestimates the volume of normal parenchyma in benign testicular masses.
abstract: OBJECTIVE
  In children with testicular masses characteristic ultrasonographic features may occasionally allow the preoperative determination of a benign process and permit a testis sparing procedure to be performed. Often the amount of normal parenchyma surrounding the mass may be seemingly negligible, which may prompt some investigators to wonder what a testis sparing procedure might realistically spare.
  
  
  METHODS
  We retrospectively reviewed 7 consecutive patients with intratesticular lesions who underwent surgical exploration. Several of these children seemingly had complete replacement of the testis with the pathological process with little to no discernible normal parenchyma. The surgical technique involved delivery of the testis and control of the vessels. The capsule was incised and the normal parenchyma was bluntly separated to the level of the tumor. The mass was then mobilized circumferentially and enucleated intact. The residual parenchyma was reapproximated, the capsule was closed and the testicle was replaced in the scrotum. All patients were followed postoperatively by physical examination and ultrasonography.
  
  
  RESULTS
  The series consists of 7 children 10 to 188 months old (mean age 68). The final diagnosis was cystic teratoma in 4 cases, epidermoid tumor in 2 and a simple cyst in 1. Postoperative physical examinations revealed symmetrical testes. Postoperative ultrasonography demonstrated normal echo texture and testicular volumes. Furthermore, no tumor recurrence was detected.
  
  
  CONCLUSIONS
  Classic ultrasonographic patterns of testicular masses may permit preoperative identification of a benign process, permitting a testis sparing procedure to be planned. However, ultrasonography underestimates the amount of normal residual parenchyma because this tissue is compressed against the capsule into a thin rim. The amount of normal residual parenchyma identified on preoperative ultrasound should not be used as a factor when deciding whether a testis sparing procedure might be appropriate.
authors: Section of Pediatric Urology, Columbus Children's Hospital, The Ohio State University, Columbus, Ohio 43205, USA.
authors: Ashay S
authors: AS
authors: Patel
authors: Brian D
authors: BD
authors: Coley
authors: Venkata R
authors: VR
authors: Jayanthi
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006801:Humans; D007223:Infant; D008297:Male; D009364:Neoplasm Recurrence, Local; D010808:Physical Examination; D012189:Retrospective Studies; D013724:Teratoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D014463:Ultrasonography