Are ultrasonographic measurements a reliable parameter to choose non-palpable testicular masses amenable to treatment with sparing surgery?

PURPOSE: To analyze the dimensional characteristics between non-palpable testicular masses detected during ultrasonographic (US) study and their postoperative dimensions reported in definitive histological diagnosis, and evaluate if the sonographic measurements may be a relevant parameter to improve the identification of testicular lesions amenable to treatment with testicular-sparing surgery (TSS). METHODS: A total of 77 patients who underwent radical orchiectomy or TSS for non-palpable testicular masses suspected for malignant neoplasms were included into this study. Preoperative US studies were also carried out in all patients to evaluate the diameter, volume and sonographic characteristics of the testicular lesions and the contralateral testes. All patients underwent inguinal orchiectomy or testicular exploration (for masses ≤1.5 cm) through an inguinal approach. RESULTS: The mean age at the time of diagnosis was 36.5 years. The predominant finding was a hypoechoic mass (71.4%). The vast majority of all malignant masses appeared markedly hypoechoic (89.8%); moreover, this differed significantly from benign lesions (39.3%, p<0.001). Calcified lesions were significantly associated with benign tumors (77.8%, p<0.002). The mean maximum lesion diameter of the affected testicle determined by preoperative US study was 14.1 mm (range 7-21). The mean maximum lesion determined postoperatively by pathology was 13.4 mm (range 5-20). Tumor lesions estimated by US study were more accurate in benign tumors, but the results were not statistically significant (p=0.323). CONCLUSIONS: We demonstrated that the sonographic diameter of the testicular lesions seems to be one of the most important parameter for the indication of an elective TSS and US is an accurate method for detecting and measuring these lesions.

Clinical performance and utility of a NNMT-based urine test for bladder cancer.

BACKGROUND: Bladder cancer (BC) represents the most common neoplasm of the urinary tract. Although cystoscopy and urine cytology represent the gold standard methods to monitor BC, both procedures have limitations. Therefore, the identification of reliable biomarkers for early and noninvasive detection of BC is urgently required. METHODS: In this study, we analyzed nicotinamide N-methyltransferase (NNMT) expression in urine samples from 55 BC patients and 107 controls, using real-time polymerase chain reaction (PCR). Receiver operating characteristic (ROC) analysis was used to identify the best cutoff value to discriminate BC patients from healthy donors, and to evaluate the diagnostic accuracy of a urine-based NNMT test. RESULTS: The results demonstrated that urinary NNMT expression was significantly (p<0.05) higher in BC patients. Moreover, a significant (p<0.05) inverse correlation was found between NNMT expression and histological grade. The ROC analysis revealed that a ΔCq of 13.3 was the best cutoff value, since it was associated with the highest combination of sensitivity and specificity. Moreover, the area under the curve (AUC) value was 0.913 (p<0.05), indicating the excellent diagnostic accuracy of a urine-based NNMT test. CONCLUSIONS: Our data indicate that NNMT is a promising biomarker that could be used to support the early and noninvasive diagnosis of BC.

Testicular sparing surgery in small testis masses: A multinstitutional experience.

INTRODUCTION: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. MATERIALS AND METHODS: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397) which comprises: 1) testicular tumor markers, 2) repeated scrotal ultrasound at the tertiary center, 3) surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. RESULTS: Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15). Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3%) with immediate radical orchiectomy and 17/28 (60.7%) with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma), benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma), benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis), and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. CONCLUSIONS: The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single testicular nodules below 15 mm is a safe option, but requires a standardized pathway in diagnosis. Our pathway has shown good reliability and security profile to be applied in a multicenter management for small scrotal masses. Our study has shown the reliability of the diagnostic-therapeutic pathway in the management of single testicular masses. The higher incidence of benign lesions in 60% of patients makes often orchiectomy an overtreatment.

Rare presentation of a testicular angiofibroma treated with testis sparing surgery.

INTRODUCTION: Testicular benign tumors are very rare (< 5%). Testicular Angiofibroma (AF) is one of those, however the gold standard of treatment and follow-up is still unclear. CASE REPORT: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. CONCLUSION: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.