Article
Organ-sparing surgery in testicular sex cord-stromal tumors: results of a little series
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Authors
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Emanuela Trenti
- Krankenhaus Bozen, Urologie, Bozen, Italien
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Salvatore Palermo
- Krankenhaus Bozen, Urologie, Bozen, Italien
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Tamara Tischler
- Krankenhaus Bozen, Urologie, Bozen, Italien
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Evi Comploj
- Zentralkrankenhaus Bozen; Department of Research, College of Health Care Professions, Claudiana
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Helmuth Schuster
- Krankenhaus Bozen, Urologie, Bozen, Italien
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Carolina D'Elia
- Krankenhaus Bozen, Urologie, Bozen, Italien
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Esther Hanspeter
- Krankenhaus Bozen, Urologie, Bozen, Italien
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Armin Pycha
- Zentralkrankenhaus Bozen; Sigmund Freud Private University, Medical School, Wien Österreich
| Published: | May 17, 2018 |
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Outline
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Objective: We present a small series of patients with testicular sex-cord stromal tumors (TSCST), with the intent to evaluate the possibility to standardize the surgical treatment. Materials and
Methods: Between 2005 and 2016 a TSCST was diagnosed in 11 patients at our department. The mean age was 46.8 years (14-83). Alpha fetoprotein (alfa-FP), human chorionic gonadotropin (HCG) and lactate dehydrogenase (LDH) were assessed preoperatively in all patients. During the operation frozen sections were request in order to choose the definitive surgical strategy. A testis sparing surgery (TSS) was performed always in case of TSCST. A thoracic-abdominal computed tomography (CT) was performed after the surgery. The follow up was scheduled according with the EAU guide-lines for testicular tumors.
Results: All lesions were intraparenchimal and dectected in ultrasound. Alpha-FP, HCG and LDH were negative in all patients. The frozen sections showed a TSCST in 10 patients, which were treated with TSS. In 1 patient was performed an orchiectomy because the frozen section suspected a seminoma but the definitive histology showed a TSCST. The mean tumor size was 11 mm (7-40). The definitive histology showed no evidence of risk factors (angioinvasion, severe nuclear atypia, margin infiltration, necrosis and high mitoses-index) in all patients. The CT was negative in all cases. The mean follow up was 43.8 months (10-108). All patient are free from disease and alive except one, who died after 108 months for other reasons.
Conclusion: TSCST represent 3-5% of all testicular tumors. A malignant behavior has been reported in about 10% of all cases. Because of his low incidence and the lack of data, their management remain controversial. The potential malignancy may can be a reason for urologists to perform an orchiectomy and TSS remains only an option. Our small prospective series shows, that TSS could be safely performed if there is a TSCST in frozen sections when the tumor size doesn’t exceed 4 cm. In presence of one or more pathologic risk factors in the definitive histology a radical surgery should always be considered. Although the good prognosis of these tumors we point out the need of a regular follow up.
