Frozen Section Assessment in Testicular and Paratesticular Lesions Suspicious for Malignancy: Its Role in Preventing Unnecessary Orchiectomy.
M Kristina Subik, Jennifer Gordetsky, Jorge L Yao, P Anthony di Sant'Agnese, Hiroshi Miyamoto. University of Rochester, NY
Background: Men with testicular and paratesticular lesions clinically suspicious for malignancy may benefit from a frozen section assessment (FSA) in order to spare unnecessary orchiectomy. The purpose of this study is to investigate the role of FSA in suspected testicular/paratesticular tumors.
Design: We performed a retrospective review of intraoperative testicular and paratesticular FSAs performed at our institution between the years 1993-2010.
Results: FSAs were performed on 41 testicular lesions [age: 5-60 (mean 32.5) yr; lesion size: 0.5-9.7 (mean 2.1) cm] and 19 paratesticular lesions [age: 26-76 (mean 43.3) yr; lesion size: 0.4-11.0 (mean 2.8) cm] prior to the decision to complete radical orchiectomy. Benign/malignant diagnoses on FSA were reported in 25/16 testicular cases and 16/3 paratesticular cases, respectively. Of the 25 benign testicular FSAs, 6 cases resulted in orchiectomy. Permanent diagnoses on the 6 orchiectomy specimens included epidermoid cyst (2 cases), large cell calcifying Sertoli cell tumor, fibrous pseudotumor, abscesses, and sarcoidosis. Of the 16 malignant testicular FSAs, orchiectomy was performed in 13 cases with germ cell tumor, but not in the remaining 3 cases with lymphoma. Of the 16 benign paratesticular FSAs, 2 cases, both fibrous pseudotumors, resulted in orchiectomy due to questionable viability of the testicles. In an additional paratesticular lesion, a malignant diagnosis of small round blue cell neoplasm made on FSA resulted in orchiectomy and then the final diagnosis was revised to reactive changes. There were statistically significant differences in the size of the testicular (p=0.001) or paratesticular (p<0.001) lesions between benign and malignant FSAs. Similarly, among the 16 cases with benign diagnosis on paratesticular FSA, the ages of the patients (p=0.031) or the sizes of the lesions (p=0.065) were different between 14 cases of excisional biopsy only vs. 2 cases of ultimate orchiectomy. Additionally, 34 FSAs were performed directly on orchiectomy specimens, including 26 malignant neoplasms, 6 benign neoplasms, and 2 other benign conditions.
Conclusions: An orchiectomy was performed in six testicular and two paratesticular cases despite a benign diagnosis on FSA. Thus, in 33 of 41 (80.5%) cases with benign FSAs in addition to all 3 cases of lymphoma, orchiectomy was successfully avoided. In a paratesticular case, a false-positive diagnosis resulted in unnecessary orchiectomy. Further analyses revealed that the size of the lesions was associated with the risk of malignancy.
Category: Genitourinary (including renal tumors)
Monday, February 28, 2011 2:45 PM
Platform Session: Section A, Monday Afternoon