title: Testicular Nodules Suspected for Malignancy. Does the Pathologist Make the Difference for Organ-Sparing Surgery? .
abstract: OBJECTIVE
  To evaluate the factors that influence decision-making after frozen section examination (FSE) when a urologist sends a surgical specimen of a testicular nodule to a pathologist.
  
  
  METHODS
  We retrieved, from surgical and pathological files of our center from 2008 to 2014, the clinical information of 15 patients who underwent an explorative inguinal testicular surgery for an intratesticular nodule suspected for malignancy and managed with intention of testicular-sparing surgery. We identify the factors that influenced the correlation between outcome of the FSE and final histopathological report.
  
  
  RESULTS
  Mean diameter of the testicular nodules was 8.37 mm. Very small lesions (< 5 mm) were detected in 4 cases (27%), with definitive diagnosis of seminoma in 2 of those (50%). At clinical evaluation 2 nodules were palpable but not malignant at definitive diagnosis. Overall, at definitive histopathological nodule report, a pathologist diagnosed 5 Leydig cell tumors, 4 seminomas, 1 adenomatoid tumor, 1 Sertoli cell tumor, 1 malignant teratoma, and a hemorragic infiltrate in 3 cases. FSE on testicular biopsy reported intratesticular neoplasia only in all cases of definitive diagnosis of seminoma. We observed a concordance between nodule FSE and definitive pathologic report in 11 cases (73%) and in 87% of ancillary testicular biopsies. Discordance was observed in cases lacking the availability of a dedicated pathologist.
  
  
  CONCLUSIONS
  In cases of small testicular nodule FSE may aid the surgery decision and avoid overtreatment. The close collaboration between urologist and a dedicated pathologist is very useful in reducing diagnostic and therapeutic errors.
authors.forename: Andrea
authors.initials: A
authors.lastname: Fabiani
authors.forename: Alessandra
authors.initials: A
authors.lastname: Filosa
authors.forename: Tiziana
authors.initials: T
authors.lastname: Pieramici
authors.forename: Gabriele
authors.initials: G
authors.lastname: Mammana
mesh_terms: D000293:Adolescent; D000328:Adult; D005629:Frozen Sections / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D010340:Pathology, Surgical / Q000379:methods*; D013736:Testicular Neoplasms / Q000175:diagnosis* / Q000601:surgery*; D055815:Young Adult