Diagnostic Imaging Online
December 18, 2003
Ultrasound aids diagnosis, management of testicular tumors
While the clinical literature shows most palpable tumors of the testes carry a strong chance of malignancy, discrepancies still exist regarding impalpable ones. Ultrasound could help in the diagnosis and management of impalpable lesions, according to Italian researchers.
"Impalpable ultrasonographic intratesticular lesions are not always malignant," said principal investigator Dr. Luca F. Carmignani, an assistant professor of urology at the University of Milan's School of Medicine.
Carmignani and colleagues assessed the diagnosis and management of focal testicular lesions found during ultrasound examinations performed on 1320 consecutive patients. They found that more than 80% of these lesions were benign and could be treated with conservation surgery.
Out of 27 patients with focal testicular lesions, 10 were nonpalpable. Biopsy results from seven of those 10 patients showed focal Leydig cell hyperplasia in one case, fibrosis in three, infarction in two, and mesothelial hyperplasia in one. All seven underwent conservation surgery.
Among the remaining three patients, biopsy showed diffuse Leydig cell tumor in two of them, and an adenomatoid tumor in one. All three underwent orchiectomy.
Out of the 17 patients with palpable tumors, biopsy results for nine showed four pure seminomas, four embryonal carcinomas, and one diffuse Leydig cell hyperplasia. All nine underwent orchiectomy.
Biopsy results for the remaining eight palpable tumor patients showed large-cell calcifying Sertoli's cell tumor, adenomatoid tumor, pseudofibrotic tumor of the tunica albuginea, epidermoid cyst, tubular fibrosis, non-Hodgkins's lymphoma, and two cases of Leydig cell tumor. These patients underwent conservation surgery.
The study was published in the November issue of the Journal of Urology.
Clinical evidence suggests the incidence of testicular cancer is increasing worldwide. While scrotal ultrasonography's use in the urological diagnostic workup has also increased, its ability to detect malignant tumors has not been completely established, Carmignani said.
Studies on the subject are contradictory, and there are no management guidelines available. But recent studies have reported the correlation between hypoechoic impalpable nodules and classic seminoma, he said.
For more information from the Diagnostic Imaging archives:
Handheld ultrasound creates new turf, practice challenges
Color Doppler enables scrotal diagnosis
Ultrasound contrast alters prostate protocol
Real-time 3D Doppler imaging impresses early clinical users
-- By H.A. Abella
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