Akademik Veri Yönetim Sistemi
UROONKOLOJI BULTENI-BULLETIN OF UROONCOLOGY, cilt.22, sa.3, ss.89-93, 2023 (ESCI)
Objective: Testicular tumors can be seen bilaterally in 2-3% of cases as synchronous or metachronous. The long cancer-specific survival in early-stage testicular cancer requires consideration for fertility and quality of life issues because of organ loss in these patients. In the present case series, the surgical outcome and histopathological features of testis-sparing surgery were evaluated using bench work after a standard radical orchiectomy in testicular tumor patients with normal contralateral testis. Materials and Methods: Patients with a testicular mass confirmed by ultrasonography and/or magnetic resonance imaging and normal contralateral testis were included in the study. All patients underwent standard radical orchiectomy. Partial orchiectomy was performed on a separate operating table (bench) following radical orchiectomy. After visual evaluation of the removed tumor mass, seven biopsies were taken from the tumor bed for frozen section examination (FSE). If a residual tumor was found in the tumor bed because of FSE, parenchymal resection was performed until a negative margin was achieved. The patients' age, tumor marker levels, tumor type, tumor diameter, rete testis invasion, epididymis and spermatic cord invasion, necrosis, and presence of lymphatic-vascular invasion were recorded. Results: Sixteen patients were included in the study. The mean age of the patients was 31.6 +/- 11.6 years. The mean tumor diameter was 26.9 +/- 15.3 mm, and the mean tumor-testicular-volume ratio was 33.2 +/- 24.9 percentage. The surgical margin was positive in 12.5% (n=2/16) patients in the FSE. In these two patients, the tumor-testicular volume ratio was above 50%, the tumor diameter was greater than 50 mm, and necrosis and invasion of the tunica albuginea were observed in the final histopathology. The tumor histopathology of patients was pure seminoma, non-seminomatous germ cell tumors, mixed germ cell tumor, sex cord stromal tumor, and fibrosis in 50% (n=8/16), 12.5% (n=2/16), 25% (n=4/16) 6.5% (n=1/16) and 6.5% (n=1/16) of the cases, respectively. Histopathological examination revealed 37.5% (n=6/16) intratubular germ cell neoplasia in the adjacent testicular tissue. Conclusion: Our experience in the present case series shows that testis-sparing surgery is technically straightforward. Surgical margin positivity can be detected in patients with a large tumor or a high tumor-testicular-volume ratio. FSE is useful for detecting surgical margin positivity.