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Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy

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Abstract

Purpose

Testis sparing surgery (TSS) is a well-known technique in the treatment of small testicular masses. Grayscale ultrasound (US), color/power Doppler US (CPDUS) and contrast-enhanced ultrasound (CEUS) are considered the best diagnostic imaging tools in those patients. Aim of this study was to assess the role of US imaging in the detection of small testicular masses in monorchid patients after orchiectomy for malignant neoplasm, and in guiding surgery to reach the target and also to differentiate lesions which presented vascular activity within the mass.

Methods

From January 2011 to October 2014, 18 patients were enrolled in this study. They had previously undergone orchiectomy and were investigated for suspected contralateral disease. During routine follow-up, all patients underwent grayscale US. If findings were positive, CPDUS and CEUS were performed and eventually all patients underwent surgery. After exteriorization of the testis, the small mass was identified by intraoperative US, and a needle was placed under US guidance. After excision of the mass, frozen section examination was performed. When malignancy was found, radical orchiectomy was performed; if histological outcome was negative, the healthy testis was conserved.

Results

All patients underwent grayscale US examination, which showed small hypoechoic masses. Each mass identified at US imaging was confirmed at surgery. All patients underwent CPDUS; 12/19 lesions showed blood flow while 7/19 showed absence of blood flow. At CEUS, 16/19 lesions showed enhancement and subsequent histological examination revealed that 8 were seminomas and 3 were Leydig cell tumors. In 5/19 cases CEUS showed the presence of lesions (focal inflammatory lesions) and in 3/19 cases CEUS was negative.

Conclusions

TSS in monorchid patients may be a safe procedure leading to excellent results. We therefore consider it a valid alternative to radical orchiectomy, and US imaging is essential to guide the resection of non-palpable neoplasms and to exclude concomitant lesions.

Riassunto

Scopo

La testis sparing surgery (TSS) è una tecnica ben nota nel trattamento di piccole masse testicolari. L’ecografia in scala di grigi (US), il color/power Doppler (CPDUS) e l’ecografia con mezzo di contrasto (CEUS) sono considerati i migliori strumenti di diagnostica per immagini in questi pazienti. Scopo di questo studio è stato quello di valutare il ruolo dell’imaging ecografica nell’individuazione delle piccole masse testicolari nei pazienti monorchidi dopo orchiectomia per neoplasia maligna, nel ruolo di guida durante l’intervento chirurgico e nella differenziazione delle lesioni che presentavano attività vascolare dentro la massa.

Metodi

Da Gennaio 2011 a Novembre 2014, 18 pazienti (19 lesioni), orchiectomizzati per neoplasia, durante il follow-up di routine, sono stati sottoposti a ecografia. Se positivi, venivano sottoposti a CPDUS e CEUS ed ad intervento chirurgico. La piccola massa, era identificata e sotto guida ecografica marcata con ago. Dopo l’asportazione della massa, è stato eseguito l’esame istologico estemporaneo. In caso di malignità, veniva eseguita una orchiectomia radicale; se l’esito istologico era negativo, il testicolo sano veniva conservato.

Risultati

In tutti i pazienti l’ecografia ha mostrato 19 piccole masse ipoecogene confermate all’intervento chirurgico. Al CPDUS; 12/19 hanno mostrato presenza di flusso ematico, 7 hanno mostrato assenza di segnale. Alla CEUS, 16/19 sono risultate positive e l’esame istologico ha dimostrato 8 seminomi, 3 tumori a cellule di Leydig. In 5 casi la CEUS ha mostrato la presenza di lesioni (lesioni infiammatorie focali) e in 3 è stata negativa.

Conclusioni

La TSS nei pazienti monorchidi può essere una procedura sicura che porta a eccellenti risultati. Tale tecnica può essere una valida alternativa all’orchiectomia radicale. L’imaging ecografico è essenziale per il riconoscimento e la caratterizzazione della lesione, per guidare la resezione delle neoplasie non palpabili e per escludere lesioni concomitanti.

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Conflict of interest

All the above authors declare no conflict of interest at all.

Ethical standard

All human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the Helsinki Declaration of 1975 and its late amendments.

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Authors and Affiliations

  1. Dipartimento di Radiologia Centrale, Università degli studi “La Sapienza”, Viale del Policlinico, 155 00161, Rome, Italy

    F. M. Drudi, F. Maghella, D. Messineo, M. Ciccariello, V. Cantisani, F. Malpassini, M. Liberatore & F. D’Ambrosio

  2. Dipartimento di Scienze Chirurgiche, Sezione interdisciplinare di Chirurgia “F. Durante”, Università degli studi “La Sapienza”, Viale del Policlinico, 155 00161, Rome, Italy

    G. Martino

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  1. F. M. Drudi
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  2. F. Maghella
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  3. G. Martino
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  4. D. Messineo
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  5. M. Ciccariello
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  6. V. Cantisani
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  7. F. Malpassini
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  8. M. Liberatore
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  9. F. D’Ambrosio
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Correspondence to F. M. Drudi.

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Drudi, F.M., Maghella, F., Martino, G. et al. Detection of small testicular masses in monorchid patients using US, CPDUS, CEUS and US-guided biopsy. J Ultrasound 19, 25–28 (2016). https://doi.org/10.1007/s40477-015-0158-1

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  • DOI: https://doi.org/10.1007/s40477-015-0158-1

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