年輕男性良性睪丸腫瘤部分睪丸切除案例報告

蔡牧堯、康智雄

高雄長庚紀念醫院

Partial orchiectomy of a solid testicular benign tumor in young male

Mu-Yao Tsai, Chih-Hsiung Kang

Divisions of Urology, Department of Surgery, Chang Gung Memorial Hospital, Kaohsiung

Introduction:

   Partial orchiectomy was a feasible operation in selected patient to preserve fertility. NCCN guidelines demonstrated the criteria of testicle-sparing surgery, including of solitary tumor, tumor diameter<2 cm, synchronous bilateral germ cell tumors, a solitary testicle with a mass suspicious for germ cell tumor, or a functionally solitary testicle. We present a case to perform partial orchiectomy following this guidelines to preserve patient’s testicular function.

Case report:

A 25-year-old man presented to the outpatient urology clinic with accidentally a palpable painless right testicular mass. Laboratory studies were notable for alpha-fetoprotein:5.5 ng per milliliter, lactate dehydrogenase : 127 U per liter, Beta Human chorionic gonadotropin: <2 mIU per milliliter. Scrotum echography showed lamellated "onion skin" appearance with mix echogenicity rings without blood flow in it. T2-weighted Magnetic Resonance Imaging showed a 2.2 cm lesion with low-intensity rim and alternating concentric low signal intensity rings. Ultrasound-guided percutaneous testicular biopsy revealed keratin material only. All of which suggested the diagnosis of a benign epidermoid cyst. Then, we performed partial orchiectomy for this patient. Panel B demonstrated the transection of the mass with layers of keratinous debris (arrows). The final pathology revealed the cyst filled with keratin flakes and surrounded by fibrous tissue.

Discussion:

Generally, most of testicular tumors are malignant, including seminoma, choriocarcinoma lymphoma, and teratoma which are all treated with radical orchiectomy with/without radiation or systemic chemotherapy. Benign testicular lesions are rare and only around 5%. In this case, normal serum level of tumor markers, unique "onion skin" appearance on echography and keratin materials in pre-operative biopsy diagnosed the benign disease.

Conclusion:

Organ-sparing surgery might be a better choice for young patients to preserve the testicular functions of endocrine and fertility following strict surgical criteria.