Four nonpalpable testicular parenchymal masses were discovered (age range of 22 to 31 years.) The mass size ranged from 5 to 6 mm in maximum diameter and serum tumor markers were negative in all patients. Frozen section pathology indicated benign lesions in all patients and permanent pathology revealed seminoma in 2 of the patients who underwent delayed radical orchiectomy. The final pathology of orchiectomy specimens did not reveal residual invasive tumor.

The incidence of incidental tumors in this large series is 0.4 %. The incidence of malignant tumors was 0.02%. This certainly indicates that screening USG is not a valuable modality. Unfortunately the authors do not fully characterize the population to make a comment regarding screening in subpopulations such as the infertile male. Nevertheless, the urologist treating infertile men needs to be aware of the possibility of encountering nonpalpable masses and the approach to them. The unreliability of frozen section assessment needs to be discussed with a patient prior to embarking on exploration including the implications for future management. It is appropriate to include parenchyma surrounding the primary lesion at the time of excisional biopsy. This information may affect subsequent management options. Intraoperative USG guidance has been invaluable in our experience.

J Urol 2006 Jul;176(1):96-8; discussion 99

Written by Harris M. Nagler, MD, a Contributing Editor with UroToday.

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