Paffenholz P, et al. - Herein, the diagnostic and therapeutic work-up of testicular masses was assessed to improve preoperative stratification algorithms. Researchers recommended considering a non-germ cell tumor in small testicular masses with a volume of <2.8cm³ with normal tumor markers or hormone disorders. Avoiding immediate orchiectomy was also recommended, favouring testis-sparing surgery.

• A total of 522 patients diagnosed with primary testicular masses of unknown malignant potential were retrospectively analyzed at a single-center.

• Data demonstrated that 28 (5%) patients showed a primary benign tumor after resection: 9 (32%) Leydig cell tumors, 9 (32%) epidermoid cysts, 8 (29%) adenomatoid tumors and 2 (7%) Sertoli cell tumors.
• Significantly smaller mean tumor volume of benign tumors vs malignant tumors was documented (0.75cm³ [0.1-2.1] vs 15cm³ [4.5-39.9], p=<0.001).
• Researchers noted that at a cut-off value of 2.8cm³, tumor volume most accurately differentiated between benign and malignant disease and was a predictor for malignancy (Sensitivity 83%, specificity 89%, OR 1.389 [95%CI 1.035-1.864], p=0.029).
• Significantly longer duration of symptoms was reported in patients suffering from benign tumors (365 days [25.5.-365] vs 20 days [7-42], p=<0.001).
• Also, it was noted that tumors markers were unaltered in benign lesions.
• Significantly higher numbers of fertility disorders or cryptorchidism (p=<0.001) as well as a tendency towards lower levels of testosterone (3.9μg/l [0.9-4.9] vs 5.3μg/l [3.5-6.8], p=0.084) was noted in benign tumors.
• In addition, no relapse was reported at follow-up in patients on whom testis-sparing surgery was performed, which included a total of 22 (79%) of all benign tumors.