title: Testis-Sparing Surgery in Small Testicular Masses Not Suspected to Be Malignant.
abstract: Fifteen patients with small testicular masses not suspected to be malignant were included in the study, and permanent and frozen section analyses were evaluated. As a result frozen analysis, preoperative externalization of the suspected malignancy with a physical examination, ultrasonographic evaluation, and serum tumor marker analysis were concluded as key points for accurate decision making between TSS and radical orchiectomy.
  
  
  BACKGROUND
  We aimed to determine the safety, efficacy, and the concordance of permanent and frozen section analysis (FSA) of testis-sparing surgery (TSS) in patients who had small testicular masses that were not suspected to be malignant.
  
  
  METHODS
  Fifteen patients who underwent TSS were included in the study. TSS was performed for the patients who had testicular lesions <25 mm and testicular lesion volume <30% of the whole testis. All patients had normal serum tumor marker levels and ultrasonographic evaluation did not indicate malignancy. Surgery was performed via an inguinal approach with temporary cord occlusion and FSA of the lesions. Benign findings allowed for TSS, and cancer prompted total orchiectomy.
  
  
  RESULTS
  The mean patient age was 25.33 (range, 20-36) years. The predominant complaint was swelling (9 patients). The mean lesion diameter was 16 mm (range, 5-26 mm). Fourteen of all cases (93%) had benign pathology and underwent TSS. Only 1 patient, whose FSA revealed malignant formation, underwent radical orchiectomy. Final pathology of this patient was seminoma. Complete histopathologic concordance was observed between the results of frozen and permanent sections. TSS was performed with no intra- or postoperative complications. After a mean follow-up of 23 months (range, 6-44 months) all patients, except 3 who were lost to follow-up, were free of disease.
  
  
  CONCLUSIONS
  The main key points for accurate decision-making between TSS and radical orchiectomy are intraoperative FSA and preoperative externalization of possible suspected malignancy with physical examination, ultrasonographic evaluation, and serum tumor marker analysis.
authors.affiliation: GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey.
authors.forename: Ferhat
authors.initials: F
authors.lastname: Ates
authors.affiliation: GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey.
authors.forename: Ercan
authors.initials: E
authors.lastname: Malkoc
authors.affiliation: GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey. Electronic address: murat804@yahoo.com.
authors.forename: Murat
authors.initials: M
authors.lastname: Zor
authors.affiliation: Eskişehir Military Hospital, Urology Department, Istanbul, Turkey.
authors.forename: Zafer
authors.initials: Z
authors.lastname: Demirer
authors.affiliation: GMMA Medical Faculty, Urology Department, Ankara, Turkey.
authors.forename: Bilal Firat
authors.initials: BF
authors.lastname: Alp
authors.affiliation: GMMA Haydarpasa Research and Training Hospital, Urology Department, Istanbul, Turkey.
authors.forename: Seref
authors.initials: S
authors.lastname: Basal
authors.affiliation: GMMA Medical Faculty, Urology Department, Ankara, Turkey.
authors.forename: Ali
authors.initials: A
authors.lastname: Guragac
authors.affiliation: GMMA Medical Faculty, Urology Department, Ankara, Turkey.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Yildirim
mesh_terms: D000328:Adult; D006801:Humans; D008297:Male; D009919:Orchiectomy; D013736:Testicular Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery*; D013737:Testis / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D014463:Ultrasonography; D055815:Young Adult
keywords: Frozen sections; Orchiectomy; Organ-sparing treatments; Testicular neoplasms; Ultrasonography