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Song G, Xiong GY, Fan Y, Huang C, Kang YM, Ji GJ, Chen JC, Xin ZC, Zhou LQ. The role of tumor size, ultrasonographic findings, and serum tumor markers in predicting the likelihood of malignant testicular histology. Asian J Androl 2020; 21:196-200. [PMID: 30648671 PMCID: PMC6413548 DOI: 10.4103/aja.aja_119_18] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
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.
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Affiliation(s)
- Gang Song
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
| | - Geng-Yan Xiong
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
| | - Yu Fan
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
| | - Cong Huang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
| | - Yong-Ming Kang
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China.,Department of Urology, Suining Central Hospital, Suining 629000, China
| | - Guang-Jie Ji
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
| | - Jin-Chao Chen
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
| | - Zhong-Cheng Xin
- Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China.,Department of Andrology, Peking University First Hospital, Beijing 100034, China
| | - Li-Qun Zhou
- Department of Urology, Peking University First Hospital, Beijing 100034, China.,Institute of Urology, Peking University, National Urological Cancer Center, Beijing 100034, China
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Ramjit A, Shin C, Hayim M. Complete testicular infarction secondary to epididymoorchitis and pyocele. Radiol Case Rep 2020; 15:420-423. [PMID: 32071663 PMCID: PMC7016336 DOI: 10.1016/j.radcr.2020.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/02/2020] [Indexed: 11/19/2022] Open
Abstract
Epididymoorchitis is a relatively common urologic condition involving the scrotum which presents with unilateral pain and swelling. It is typically treated with antibiotics but can progress to complications such as scrotal pyocele. Global testicular infarction is an exceedingly rare but devastating complication of epididymoorchitis. Grey scale and color Doppler ultrasound demonstrate testicular hypovascularity with subsequent hypoechoic changes of the testicular parenchyma. Scrotal MRI shows T2 hyperintense changes through the testicle with nonenhancement of the testicular parenchyma post contrast, consistent with infarction. The cause of global infarction in epididymitis is uncertain but may be due to mixed arterial and venous insufficiency. This case illustrates a 41-year-old male that developed acute left testicular pain. Initial ultrasound showed an enlarged left testicle with hyperemia. The patient's symptoms progressed and a scrotal MRI demonstrated a lack of left testicular enhancement consistent with global infarction, as well as an adjacent pyocele.
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Affiliation(s)
- Amit Ramjit
- Donald and Barbara Zucker School of Medicine at Hofstra, Department of Radiology, Northwell at Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA
- Corresponding author.
| | - Christopher Shin
- Department of Medicine, Stony Brook University Hospital, 101 Nicolls Road, Stony Brook, NY, USA
| | - Morris Hayim
- Donald and Barbara Zucker School of Medicine at Hofstra, Department of Radiology, Northwell at Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, USA
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