The purpose of this study was to evaluate the diagnostic performance of multiparametric ultrasound (mpUS; grayscale US, color Doppler US, strain elastography, and contrast-enhanced US) in the assessment of testicular lesions with negative tumoral markers. MpUS imaging data, patient age, serum tumor markers, scrotal pain, cryptorchidism, and related clinical information were retrospectively collected for patients who underwent mpUS examination between January 2013 and December 2019. Histologic results or follow-up examinations were used as the reference standard. In total, 83 lesions from 79 patients were included in the analysis. Fifty-six patients were finally diagnosed with benign tumors, and 23 patients were ultimately diagnosed with malignant tumors. Chi-square tests or Fisher's exact tests were used to assess the difference between the two groups. Stepwise multivariate logistic regression analysis showed that lesion diameter (odds ratio [OR] = 1.072, P = 0.005), vascularization on color Doppler US (OR = 4.066, P = 0.001), and hyperenhancement during the early phase (OR = 6.465, P = 0.047) were significant independent risk factors for malignancy; however, when compared with neoplastic lesions, pain (OR = 0.136, P < 0.001), absence of vascularization on color Doppler US (OR = 1.680, P = 0.042), and nonenhancement during the late phase (OR = 3.461, P = 0.031) were strongly associated with nonneoplastic lesions. MpUS features are useful for differentiating testicular lesions with negative tumoral markers and improving the preoperative diagnosis, which may avoid inappropriate radical orchiectomy.
Male ; Humans ; Testicular Neoplasms/pathology* ; Biomarkers, Tumor ; Retrospective Studies ; Contrast Media ; Ultrasonography/methods*

The clinical predictive factors for malignant testicular histology remain unclear because of the low prevalence. Therefore, the aim of this study was to investigate predictors of malignant histology for testicular masses and decide more testis-sparing surgeries before surgery. This retrospective study enrolled 325 consecutive testicular mass patients who underwent radical orchiectomy (310/325) or testicular preserving surgery (15/325) from January 2001 to June 2016. The clinicopathological factors, including tumor diameter, cryptorchidism history, ultrasound findings, serum alpha-fetoprotein, and human chorionic gonadotropin (HCG) levels, were collected retrospectively for statistical analysis. A predictive nomogram was also generated to evaluate the quantitative probability. Among all patients, 247 (76.0%) were diagnosed with a malignant testicular tumor and 78 (24.0%) with benign histology. Larger tumor diameter (per cm increased, hazard ratio [HR] = 1.284, P = 0.036), lower ultrasound echo (HR = 3.191, P = 0.001), higher ultrasound blood flow (HR = 3.320, P < 0.001), and abnormal blood HCG (HR = 10.550, P < 0.001) were significant predictive factors for malignant disease in all testicular mass patients. The nomogram generated was well calibrated for all predictions of malignant probability, and the accuracy of the model nomogram measured by Harrell's C statistic (C-index) was 0.92. According to our data, the proportion of patients who underwent radical orchiectomy for benign tumors (24.0%) was much larger than generally believed (10.0%). Our results indicated that the diameter, ultrasonic echo, ultrasonic blood flow, and serum HCG levels could predict the malignancy in testicular mass patients.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biomarkers, Tumor/blood* ; Child ; Chorionic Gonadotropin/blood* ; Humans ; Male ; Middle Aged ; Orchiectomy ; Prognosis ; Retrospective Studies ; Testicular Neoplasms/surgery* ; Testis/pathology* ; Tumor Burden ; Ultrasonography ; Young Adult ; alpha-Fetoproteins/metabolism*

PURPOSE: Testicular microlithiasis (TM) is a relatively rare clinical entity of controversial significance characterized by the existence of hydroxyapatite microliths located in the seminiferous tubules. The aim of this study was to observe the natural course of changes in the calcific density of pediatric TM. MATERIALS AND METHODS: We included a total of 23 TM patients undergoing scrotal ultrasound (US) on at least two occasions from July 1997 to August 2014. We retrospectively analyzed the patient characteristics, clinical manifestations, specific pathological features, and clinical outcomes. We measured the calcified area and compared the calcific density between the initial and final USs. RESULTS: The mean age at diagnosis was 11.3+/-4.6 years, and the follow-up period was 79.1+/-38.8 months (range, 25.4-152.9 months). During the follow-up period, no patients developed testicular cancer. Calcific density on US was increased in the last versus the initial US, but not to a statistically significant degree (3.74%+/-6.0% vs. 3.06%+/-4.38%, respectively, p=0.147). When we defined groups with increased and decreased calcification, we found that diffuse TM was categorized into the increased group to a greater degree than focal TM (10/20 vs. 4/23, respectively, p=0.049). In addition, five of eight cases of cryptorchidism (including two cases of bilateral cryptorchidism) were categorized in the increased calcification group. CONCLUSIONS: Diffuse TM and cryptorchidism tend to increase calcific density. Close observation is therefore recommended for cases of TM combined with cryptorchidism and cases of diffuse TM.
Adolescent ; Calcification, Physiologic ; *Calculi/complications/epidemiology/pathology/physiopathology ; Child ; Cryptorchidism/diagnosis/etiology ; Densitometry/methods ; Follow-Up Studies ; Gonadoblastoma/diagnosis/etiology ; Humans ; Male ; Republic of Korea ; Scrotum/*ultrasonography ; Seminiferous Tubules/*pathology ; *Testicular Diseases/complications/epidemiology/pathology/physiopathology ; *Testicular Neoplasms/diagnosis/epidemiology/etiology

A 47-year-old man presented with a scrotal swelling. Ultrasonography of the testes showed that it was an extratesticular swelling. However, the swelling was intraoperatively found to be intratesticular. Histology showed an intratesticular leiomyoma, which is extremely rare.
Diagnosis, Differential ; Humans ; Leiomyoma ; diagnosis ; diagnostic imaging ; surgery ; Male ; Middle Aged ; Scrotum ; pathology ; Testicular Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Treatment Outcome ; Ultrasonography

Sparganosis is a parasitic infestation of human by plerocercoid larvae. Sparganum is usually reported to be found in the subcutaneous tissues as well as other organs, including scrotum. However, testicular sparganosis is extremely rare, because of strong capsule of tunica albuginea. An urban-living 54-yr-old Korean man presented with left scrotal pain for 6 yr. Both testes look normal physically. Ultrasonography revealed poorly defined, heterogeneous mass with increased echogenicity in the left testis. This case was misdiagnosed as testicular tumor and underwent orchiectomy, but was diagnosed as testicular sparganosis by histopathology. Sparganosis should be included for differential diagnosis of testis tumor in countries where sparganosis is prevalent.
Diagnosis, Differential ; Diagnostic Errors ; Humans ; Male ; Middle Aged ; Orchiectomy ; Sparganosis/*diagnosis/pathology/ultrasonography ; Testicular Neoplasms/diagnosis/ultrasonography ; Testis/pathology

OBJECTIVETo study the clinical characteristics of yolk sac tumor of the testis with concomitant testicular hydrocele in children and the association between the two conditions in order to improve the diagnosis and treatment of the disease.

METHODSWe retrospectively analyzed the clinical data of 7 cases of stage-I yolk sac tumor of the testis with concomitant testicular hydrocele. The patients ranged in age from 6 to 14 (mean 11) months. As treatment, we performed radical high spermatic cord orchiectomy after diagnosis established on intraoperative frozen sections, and conducted follow-up visits by medical examination, serum alpha-fetoprotein (AFP) detection, chest X-ray, ultrasonography and CT for 3-41 (mean 17) months, every month in the first year, every 3 months in the second year and every 6 months in the third year after surgery.

RESULTSPostoperative pathology confirmed yolk sac tumor in all the cases, with negative incisal margin. The level of serum AFP were decreased to normal in 6 cases within 1 month after surgery, all diagnosed as at stage I, and cured without chemotherapy. The other 1 case, with the serum AFP level of 116 microg/L at 1 month after operation, was diagnosed as at stage II and received PVC chemotherapy, but lost to follow-up at 3 months post-operatively.

CONCLUSIONYolk sac tumor of the testis with concomitant testicular hydrocele is easily misdiagnosed in children. Ultrasonography is necessitated as routine examination in its diagnosis. Radical high spermatic cord orchiectomy can be performed for patients in stage I, and chemotherapy should follow for those in stage II. Its prognosis is similar to that of other yolk sac tumors. Hitherto, there has been no evidence for a definitive correlation between yolk sac tumor of the testis and hydrocele in children.

Endodermal Sinus Tumor ; diagnosis ; diagnostic imaging ; surgery ; Humans ; Infant ; Male ; Orchiectomy ; Retrospective Studies ; Spermatic Cord ; surgery ; Testicular Hydrocele ; diagnosis ; diagnostic imaging ; surgery ; Testicular Neoplasms ; diagnosis ; diagnostic imaging ; surgery ; Testis ; pathology ; Ultrasonography ; alpha-Fetoproteins ; metabolism

Testicular microlithiasis (TM) refers to the calcium deposits within the seminiferous tubules. Owing to the wide use of scrotal ultrasonography, more cases of TM have been diagnosed clinically. TM can be associated with many conditions, including cryptorchidism, infertility, varicocele, testicular torsion, Klinefelter's syndrome, intratubular germ cell neoplasia (IGCN) and testicular germ cell tumor (TGCT), and its frequent association with IGCN, TGCT and infertility is the particular concern of urologists and andrologists. The etiology of TM is not yet certain. Its biological meaning and clinical significance have not been well defined. Currently, there are controversies on the correlation of TM with IGCN, TGCT and infertility. This article reviews the definition, prevalence, etiology, and histopathology of TM, and summarized its association with IGCN, TGCT, and male infertility as well as the management of the disease.
Calculi ; diagnostic imaging ; Germinoma ; diagnostic imaging ; Humans ; Incidence ; Male ; Scrotum ; diagnostic imaging ; Testicular Diseases ; diagnosis ; epidemiology ; pathology ; Testicular Neoplasms ; diagnostic imaging ; Ultrasonography

PURPOSE: We assessed the feasibility of testis-sparing surgery in children with testicular tumors. MATERIALS AND METHODS: Twenty-five pediatric patients who had a testicular tumor were enrolled for retrospective analysis. Testis-sparing surgery was planned in the cases with clinical features that preoperatively suggested the tumors to be benign, which was later determined intraoperatively by frozen section examination. The preoperative-fetoprotein (AFP) and transscrotal ultrasound (US) were evaluated along with the final pathology. We reviewed the immediate and late surgical complications, as well as the tumor recurrence after surgery. RESULTS: Teratoma, epidermoid cyst, yolk sac tumor, and Leydig cell tumor accounted for finding in 40%, 32%, 24%, and 4% of the patients, respectively. Based on the preoperative US, 18 patients had benign-looking tumors. According to the age-matched AFP references, 17 patients showed normal ranges preoperatively. Out of 14 patients, whose US and AFP level suggested the tumors to be benign, 10 (71.4%) were eligible for testis- sparing surgery on retrospective review. Testis-sparing surgery was performed in 5 patients, who showed the same pathology in frozen sections (3 epidermoid cysts, 2 teratomas). None of the 5 patients exhibited perioperative complications, and no recurrence or atrophy was observed at a mean follow-up of 39.8 months. CONCLUSIONS: Out of 14 patients, whose US and AFP analyses were available, 10 (71.4%) were eligible for testis-sparing surgery. Testis-sparing surgery was done in five out of the 10 patients without any complication or recurrence. Testis-sparing surgery is a feasible option in children with testicular tumors if the AFP level is within a normal range and the US suggests benign characteristics.
Atrophy ; Child* ; Endodermal Sinus Tumor ; Epidermal Cyst ; Follow-Up Studies ; Frozen Sections ; Humans ; Leydig Cell Tumor ; Pathology ; Recurrence ; Reference Values ; Retrospective Studies ; Teratoma ; Testicular Neoplasms* ; Testis ; Ultrasonography

Pure choriocarcinoma is very rare in the testes, and host immune responses including tumor infiltrating lymphocytes are unusual in choriocarcinoma. This study reports a case of pure testicular choriocarcinoma with extensive lymphocytic infiltrate and granulomatous inflammation. Scrotal ultrasonography revealed a heterogeneous, hyperechoic intratesticular mass. -human chorionic gonadotropin levels were elevated in a radioimmunoassay. The hemorrhagic and necrotic solid mass was composed of two cell populations - mononuclear pleomorphic cells and intimately admixed multinucleated smudged cells. The tumor cells were positive for cytokeratin 7, epidermal growth factor receptors, human placental lactogen and p57. Many inflammatory cells were present within the tumor. The majority of infiltrating cells were CD8-positive cytotoxic cells, which also expressed granzyme-B and TIA-1. The tumor cells were positive for FasL, but negative for Fas. Therefore, this case seemed to escape the host defense response to the tumor due to the loss of Fas, although the cellular host immune response was still active.
Tumor Markers, Biological/analysis ; Testicular Neoplasms/*pathology/ultrasonography ; Male ; Lymphocytes, Tumor-Infiltrating/*pathology ; Humans ; Granuloma/*pathology/ultrasonography ; Chorionic Gonadotropin, beta Subunit, Human/metabolism ; Choriocarcinoma/*pathology/ultrasonography ; Adult

Pure choriocarcinoma is very rare in the testes, and host immune responses including tumor infiltrating lymphocytes are unusual in choriocarcinoma. This study reports a case of pure testicular choriocarcinoma with extensive lymphocytic infiltrate and granulomatous inflammation. Scrotal ultrasonography revealed a heterogeneous, hyperechoic intratesticular mass. -human chorionic gonadotropin levels were elevated in a radioimmunoassay. The hemorrhagic and necrotic solid mass was composed of two cell populations - mononuclear pleomorphic cells and intimately admixed multinucleated smudged cells. The tumor cells were positive for cytokeratin 7, epidermal growth factor receptors, human placental lactogen and p57. Many inflammatory cells were present within the tumor. The majority of infiltrating cells were CD8-positive cytotoxic cells, which also expressed granzyme-B and TIA-1. The tumor cells were positive for FasL, but negative for Fas. Therefore, this case seemed to escape the host defense response to the tumor due to the loss of Fas, although the cellular host immune response was still active.
Tumor Markers, Biological/analysis ; Testicular Neoplasms/*pathology/ultrasonography ; Male ; Lymphocytes, Tumor-Infiltrating/*pathology ; Humans ; Granuloma/*pathology/ultrasonography ; Chorionic Gonadotropin, beta Subunit, Human/metabolism ; Choriocarcinoma/*pathology/ultrasonography ; Adult