Impalpable testis cancer

• Published in: BJU international 2003-10, Vol.92 (6), p.572-574
• Main Authors: Hindley, R.G., Chandra, A., Saunders, A., O'Brien, T.S.
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; cancer; Follow-Up Studies; Gynecology. Andrology. Obstetrics; Humans; hypoechoic; impalpable; Leydig Cell Tumor - diagnostic imaging; Leydig Cell Tumor - pathology; Male; Male genital diseases; Medical sciences; Palpation; seminoma; Seminoma - diagnostic imaging; Seminoma - pathology; Testicular Neoplasms - diagnostic imaging; Testicular Neoplasms - pathology; testis; Tumors; Ultrasonography
• ISSN: 1464-4096; 1464-410X
• DOI: 10.1046/j.1464-410X.2003.04432.x

OBJECTIVE To assess the significance of ultrasonographically detected hypoechoic lesions of the testis when the clinical examination is normal, and to highlight the management difficulties thereafter. PATIENTS AND METHODS Over a 2‐year period four patients underwent radical orchidectomy where the sole indication for surgery was a hypoechoic lesion detected on ultrasonography (US). The indications for US were persistent scrotal discomfort in two men, contralateral orchitis, and the follow‐up of testicular microlithiasis. The lesions were 4–11 mm in size and one man had several. None of the lesions were palpable; the tumour markers were normal in all patients. RESULTS Three of the testes contained seminoma; in one there were two foci of seminoma and in all intratubular germ cell neoplasia was also identified. The remaining case was a Leydig‐cell tumour. All tumours were staged as pT1 after radical inguinal orchidectomy. CONCLUSION Impalpable lesions of the testis are likely to be malignant if they are hypoechoic on US and should be considered as seminoma until proved otherwise. The management thereafter is not straightforward, but must ensure an adequate histological diagnosis if the US appearances do not resolve.