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PubMed2003

High incidence of benign testicular neoplasms diagnosed by ultrasound.

PURPOSE: We evaluated the clinical and histological significance of incidental ultrasonographic focal testicular lesions and assessed whether a conservative surgical approach may put the patient at higher oncological risk due to insufficient surgical eradication. MATERIALS AND METHODS: From October 2000 to May 2002 all patients with infertility, scrotal swelling, scrotal pain, varicocele, scrotal trauma or erectile dysfunction underwent scrotal ultrasonography. A total of 1,320 patients were investigated. Focal testicular lesions were found in 27 patients (2%), palpable nodules were present in 17 (63%) and nonpalpable incidental lesions were diagnosed in 10. Nodule diameter was 3 to 24 mm. All patients underwent explorative surgery via inguinotomy and preventive clamping of the spermatic cord. The nodules were completely removed with biopsy of the resection margins. Nonpalpable lesions were removed under ultrasonographic guidance. The testicle was only preserved when frozen section revealed a benign lesion and margins were negative. RESULTS: Of the 17 cases of palpable lesions (diameter 3 to 24 mm) conservative surgery was performed in 8 (47%). Definitive histological diagnosis showed Leydig cell tumor in 2 (25%), and large cell calcifying Sertoli's cell tumor, adenomatoid tumor, pseudofibrotic tumor of the tunica albuginea, epidermoid cyst, tubular fibrosis and non-Hodgkin's lymphoma in each 1 (12.5%). The remaining 9 patients (53%) underwent orchidectomy. Definitive histological examination revealed pure seminoma in 4 patients (44%), embryonal carcinoma in 4 (44%) and diffuse Leydig cell hyperplasia in 1 (12%). Seven of the 10 pts (70%) with nonpalpable nodules (diameter 4 to 16 mm) underwent conservative surgery. Histological study revealed focal Leydig cell hyperplasia in 1 case (10%), fibrosis in 3 (30%), infarction in 2 (20%) and mesothelial hyperplasia in 1 (10%). Orchiectomy was performed in the remaining 3 pts. Histology showed diffuse Leydig cell tumor in 2 pts (20%) and adenomatoid tumor with abscessed areas in 1 (10%). Neither atrophy nor local relapse was observed in pts who underwent conservative treatment during followup (mean: 1 month, range 19 to 9). CONCLUSIONS: The incidental diagnosis of testicular ultrasound alterations is increasing and 80% show a benign histology. In these cases a conservative surgical approach is the best option and it does not expose the patient to the risk of relapse.

Abscess↗
PubMedDate not supplied

[Psychosomatic aspects of treated testicular neoplasm patients].

We examined 26 patients who were semicastrated, lymphadenectomied and cytostatic treated because of a maligne testicular tumor to find out the secondary psychic manifestation of this organic illness. Somatic caused consequences of operation were a unilateral loss of testis and a loss of ejaculation and therefore a generative impotency. We found no evidence for a primary psychic influence on the origin of tumor illness. We could subdivide the secondary psychic manifestation in two stages: 1. The psychodynamik at the time of diagnostic and operation, 2. the specific personal mechanism of conflictmanagement in the following time, the phase of rehabilitation. In the first stage we subdivided three different states during the acute crisis with regard to regression, to mobilisation of infantil drives and to defence: 1. Disavowal, 2. Helplessness, 3. Fight. We discussed the psychodynamic and the attachment of these affective states to the psychology of neurosis. In the second stage of the secondary psychic manifestation we could find different more or less durable strategies of conflictmanagement: So called normal conflictmanagement, conflictmanagement by disavowal, by different mechanism of compensation as oral symbiotic dependences, narcissistic increasing of potency, intensified productivity, forming of religious ideal and by secondary hypochondric processes. The sexual disorders which we could state in about 1/3 of the patients existed mostly in an avoid of sexual partnership because of anxiety concerning narcissistic grief and injury of selfesteem. In older patients with special liability to crisis we found also an erective impotency. All patients with sexual disorders showed also psychoneurotic and psychosocial disorders. We discussed the results with regard to forming of hypothesis in psychosomatics, to personal and interpersonal conflictmanagement and to supportive psychotherapeutic possibilities.

Adaptation, Psychological↗
PubMed1985

Histological patterns of treatment failures in testicular neoplasms.

We reviewed 77 consecutive autopsies performed between 1965 and 1982 on patients who had been treated for germ cell tumors of the testis at our institute. Identifiable germ cell tumor was present at autopsy in 64 cases. On review, a single pattern was seen at autopsy in the majority of the cases (69.7 per cent) compared to the primary tumors, in which single patterns were seen in only 45 per cent. The occurrence of yolk sac tumor as the sole element in 6 of 29 autopsy specimens of nonseminomatous tumors after the introduction of the current standard 3-drug therapy and only once in 32 autopsies before 1976 appears significant. A possible explanation for this finding is that the yolk sac element was obscured by more aggressive and rapidly growing varieties of tumor in the earlier years but proved less responsive to chemotherapy.

Adolescent↗