Paratestiküler Kitlelerin Güncel Tanı, Tedavi ve Takip Prosedürleri

Abstract

Amaç: Paratestiküler kitlelerin testis tümörleri ile pre-op ayrımı net olarak yapılamamaktadır. Genellikle testis tümörü ön tanısıyla radikal orşiektomi yapılıp nihai patoloji sonucuna göre klinik yaklaşım planlanmaktadır. Bu noktadan hareketle, klinisyenler skrotal kitle ile karşılaştıklarında, bu kitlenin testis tümörü dışında; epididimidis, tunika vaginalis, spermatik kord, yağ-kas-bağ dokusu gibi destek dokular ve embriyonel kalıntılardan da orijin alabileceğini akılda tutmalı ve tedavi yönetimini buna göre belirlemelidir..

Gereç ve Yöntemler: Merkezimize 2008-2018 yılları arasında skrotal kitle ile başvurmuş, testis tümörü kabul edilerek ingüinal radikal orşiektomi yapılan 140 hastanın patoloji sonucu geriye dönük olarak incelendi. Patoloji sonucu paratestiküler kitle rapor edilen olguların preoperatif ve postoperatif verileri, klinik seyri, tedavi yönetimi literatür eşliğinde tartışıldı.

Bulgular: Retrospektif olarak incelenen serimizde 13 olguda paratestiküler kitle(PTK) saptandı. Bunlardan 10 hastada Adenomatoid tümör, 2 tanesinde Rabdomiyosarkom, 1 hastada Anjiomiksoma saptandı.

Sonuç: İntraskrotal yerleşimli kitlelerin köken aldığı dokunun testis kaynaklı ya da paratestiküler yapılardan mı kaynaklandığının ayırıcı tanısı sıklıkla yapılamamaktadır. Bu nedenle genelde testis tümörleri ile benzer şekilde radikal orşiektomi yapılıp kesin tanı patolojik inceleme ile konulabilmektedir. Tüm skrotal kitlelerin %2-3 ‘ünü oluşturan paratestiküler kitleler, skrotal kitle ile başvuran ve tedavi planlanması yapılan hastaların ayırıcı tanısında akla gelmesi gereken tanılar arasında kendine yer bulmalıdır. Bu konuda daha fazla sayıda hastayla ileri düzey çalışmalara ihtiyaç vardır.

Keywords

• Paratestiküler kitle
• Testis tümörü
• Radikal orşiektomi
• Rabdomiyosarkom

Current Diagnosis, Treatment and Follow-up Procedures of Paratesticular Masses

Abstract

Objective:The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly.

Materials and Methods:The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature.

Results:Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM).

Conclusion:The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Keywords

• Paratesticular mass
• Testicular tumor
• Rhabdomyosarcoma
• Radical orchiectomy

References

1. 1. Khoubehi B, Mishra V, Ali M, Motiwala H, Karim O. Adultparatesticular tumors. BJU International 2002; 90: 707-715.
2. 2.Secil M, Bertolotto M, Rocher L, Pekindil G, Stocca T, Richenberg J, et al. European Society of Urogenital Radiology Scrotal Imaging Subcommittee. J Ultrasound Med. 2017 7;36(7):1487-1509.
3. 3.Akbar SA, Sayyed TA, Jafri SZ, Hasteh F, Neill JS. Multimodality imaging of paratesticular neoplasms and their rare mimics. Radiographics. 2003 11-12;23(6):1461-76.
4. 4. Valerıo Vagnonı1, Eugenıo Brunocılla1, Riccardo Chıavına1, Marco Borghesı1, Gıovannı Passarettı1, Gıorgıo Gentile1, et al. Inguinal Canal Tumors of Adulthood; Anticancer Res. 2013 6;33(6):2361-8.
5. 5. Barry P, Chan KG, Hsu J, Quek ML. Adenomatoid tumor of the tunica albuginea. Int J Urol 2005; 12:516-518.
6. 6.P.Albers(Chair), W.Albrecht, F. Algaba, C. Bokemeyer, G.Cohn-Cedermark, K.Fizazi K, et al. European Association of Urology. Eur Urol. 2018
7. 7. David G. Bostwick, MD, MBA, FCAP and Liang Cheng, MD. Urologic Surgical Pathology, 3rd Edition;2014:830-69
8. 8. Fitzgerald S, Maclennan GT. Paratesticular liposarcoma. J Urol 2009;181:331-332.

9. 9. Unlü Y, Huq GE, Ozyalvacli G, et al. Paratesticular sarcomas: A report of seven cases. Oncol Lett 2015;9:308 312.
10. 10. Kemal Behzatoğlu, Ceren Boyacı, Buket Bambul Sığırcı. Paratesticular Tumors and Clinicopathologic Approach; Bulletin of Urooncology 2015;14:271-277
11. 11. Eble JN, Sauter G, Epstein JI, Sesterhenn IA (Eds.).World Health Organization Classification of Tumours. Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. IARC Press: Lyon 2004;267
12. 12. Kaimin Guo, Runhui Tian, Lingyun Liu, Congqi Du, Fubiao Li, HongliangWang. Adenomatoid Tumor of the Tunica Albuginea in a Boy: A Case Report and Literature Review : Case Rep Urol. 2015; 2015: 935193
13. 13. Binwu Sheng, Yin-Ping Zhang, Huan-Huan Wei, Mao Ma, Xunyi Nan. Primary adenomatoid tumor of the testis: report of a case and review of literature: Int J Clin Exp Pathol 2015;8(5):5914-5918
14. 14. Ioannis Patoulias, Christos Kaselas, Dimitrios Patoulias, Constantine Theocharides, Maria Kalogirou, et al. Epididymal Adenomatoid Tumor: A Very Rare Paratesticular Tumor of Childhood: Hindawi Publishing Corporation Case Reports in Medicine Volume 2016
15. 15. Ebru Karayiğit, Özgür Mete, Işın Kılıçaslan, Veli Uysal. Paratesticular adenomatoid tumor morphologic and immunohistochemical study of 9 cases; Türk Patoloji Dergisi 2006;22(1):32-36
16. 16. Outwater EK, Marchetto BE, Wagner BJ, Siegelman ES. Aggressive angiomyxoma: findings on CT and MR imaging. AJR Am J Roentgenol 1999;172:435-8.
17. 17 Alkıbay TR, Erkan İ, Ozen H, ve ark. Bilateral epididimal papiller kistadenoma. Turkiye Klinikleri J Med Res 1985;3:357-359.
18. 18.Lamiae Boudahna, Zineb Benbrahim, Lamiae Amaadour, Aicha Mazouz, Khadija Benhayoune, Yassir Tahiri, et al. Paratesticular rhabdomyosarcoma in adults: three case reports and review of literature; Pan African Medical Journal. 2014; 19:279
19. 19. Rogers T, Minard-Colin V, Cozic N, Jenney M, Merks JHM, Gallego S et al. Paratesticular rhabdomyosarcoma in children and adolescents—Outcome and patterns of relapse when utilizing a nonsurgical strategy for lymph node staging: Report from the International Society of Paediatric Oncology (SIOP) Malignant Mesenchymal Tumour 89 and 95 studies Pediatr Blood Cancer. 2017 9;64(9).
20. 20. Erkan Erdem, Barış Saylam, Tuba Karabacak, Murat Bozlu, Selahittin Çayan. Paratestıcular Rhabdomyosarcom: A case report wıth the revıew of the lıterature and treatment alternatıves: Türk Üroloji Dergisi: 34 (4): 479-482, 2008
21. 21. Dangle PP, Correa A, Tennyson L, Gayed B, Reyes-Múgica M, Ost M. Current management of paratesticular rhabdomyosarcoma: Urol Oncol. 2016 2;34(2):84-92.
22. 22. Gigantino V, La Mantia E, Franco R, Cecere S, Rossetti S, Di Napoli M, et al. Testicular and testicular adnexa tumors in the elderly: Anticancer Drugs. 2013 3;24(3):228-36