Is testis sparing surgery safe in patients with incidental small testicular lesions referring to a fertility center? A retrospective analysis reporting factors correlated to malignancy and long-term oncological outcomes

PurposeTo define predictors of malignancy after Testis sparing surgery (TSS) in patients referring to a fertility center with incidental small testicular lesions. Sub analyses were performed to assess predictors of Leydig cell hyperplasia and Leydig cell tumor.Materials and methodsWe performed a retrospective analysis of a single institutional database including patients treated with TSS between 2002 and 2020. All patients who underwent TSS as a first line surgical approach for incidentally detected lesions found during fertility evaluation were included.ResultsData of 64 patients were collected. The median follow up was 58 months and no recurrences were observed. At univariable logistic regression multifocal lesions, hypervascularization, microlithiasis, age and lesion size were significantly associated with malignancy. At multivariable logistic regression lesion dimension, hypervascularization and multifocal lesions were predictors of malignancy. Lesions smaller than 5 mm proved to be benign in 96.6% of the cases (32/33). Intraoperative color of the lesion and US pattern of vascularization were predictors at multivariable logistic regression for Leydig cell hyperplasia and Leydig cell tumor.ConclusionUltrasonographic characteristics and intraoperative appearance of the lesion can predict the malignant nature of small testicular lesions, guiding their surgical management in patients referring to a fertility center. Based on our experience, clinicians may safely perform TSS in carefully selected patients.     

The predominance of benign histology in small testicular masses

ObjectivesTo evaluate the concordance between testicular tumor size and benign histology in order to identify a cut-off size, below which the rate of benign lesions would be highest.Methods and materialsDuring the years 1995–2008, we performed 131 consecutive testicular operations for testicular tumors. Ten of these were testicular preserving surgery, whereas the other 121 patients had radical orchiectomy. We searched for the rate of benign lesions in the following 3 groups of tumor diameter: 10 mm or less, 11–20 mm, and greater than 20 mm. ROC analysis was used to find the optimal size cut-off below which the rate of benign lesions would be highest.ResultsBenign lesions were found in 11 patients (8%), including epidermoid cyst (n = 4), Leydig cell tumor (n = 3), fibrosis (n = 1), adenomatoid tumor (n = 2), and 1 patient with a simple cyst. Small tumor size strongly correlated with benign histology. The mean diameter of benign vs. malignant lesions was 15 mm and 41 mm, respectively (P < 0.05). The rate of benign lesions in tumors with a diameter of 10 mm or less, 11–20 mm and greater than 20 mm was 50%, 17%, and 2%, respectively. Receiver Operating characteristic (ROC) analysis with 87% sensitivity and 83% specificity revealed a cut-off value of 18.5 mm tumor diameter below which the proportion of benign lesions was 38.5% compared with 2% above it (P < 0.05).ConclusionsWhile benign lesions comprise only 8% of all testicular tumors, their proportion among small lesions is much higher. With a size cut-off of 18.5 mm, 38.5% of smaller lesions are benign. These findings support consideration of testicular exploration for small testicular lesions aiming at preservation rather than predetermined radical orchiectomy.     

Mammotome微创旋切术切除乳腺肿块1081例分析

目的探讨超声引导下Mammotome微创旋切术治疗乳腺肿块的方法和效果。方法回顾性分析1081例、1913处乳腺肿块经超声引导下Mammotome微创旋切术治疗后的疗效和随访效果。结果对1081例患者、1913处肿块行Mammotome微创旋切切除术,每处病灶平均用时4分钟,平均旋切组织15次。1063例、1894处（99.01%）为乳腺良性病变,18例、19处（0.99%）为乳腺癌。共发生术中、术后并发症39处。结论Mammotome微创旋切系统是目前临床治疗乳腺良性肿块和诊断早期乳腺癌的有效方法之一。     

第二眼超声诊断乳头状甲状腺癌131I治疗后颈部SPECT/CT异常摄碘灶性质

目的探讨第二眼超声诊断乳头状甲状腺癌131I治疗后颈部SPECT/CT显像中异常摄碘灶性质的价值。方法对41例颈部SPECT/CT中见异常摄碘灶的131I治疗后乳头状甲状腺癌患者行SPECT/CT引导下第二眼超声扫查,判断其良恶性,根据细针穿刺细胞学检查(FNAC)或随访结果进行确诊。结果对11例行FNAC:7例确诊为淋巴结转移,第二眼超声诊断其中6例为淋巴结转移、1例为良性,4例FNAC确诊为良性,第二眼超声均诊断为良性。对30例持续随访:8例第二眼超声诊断为正常淋巴结,其中6例随访诊断为良性,2例随访诊断为淋巴结转移;7例第二眼超声诊断为转移淋巴结,其中3例随访诊断为良性,4例随访诊断为复发或转移;15例第二眼超声未见病灶,随访诊断为良性。结论SPECT/CT引导下第二眼超声可提高诊断甲状腺癌131I治疗后淋巴结转移或复发的准确率。     

The absence of spermatogenesis in radical orchiectomy specimen is associated with advanced-stage nonseminomatous testicular cancer

BackgroundTo assess if clinical, pathological, and spermatogenesis factors are associated with clinical staging in patients with testicular germ cell tumors.Patients and methodsWe retrospectively reviewed the pathology reports and slides from 267 men who underwent radical orchiectomy for testicular cancer at our institution during 1998-2019. Histologic slides were reviewed and the presence of mature spermatozoa was documented. Clinical, laboratory and radiographic characteristics were recorded. Logistic regression analyses were used to identify factors associated with advanced disease stage at diagnosis.ResultsOf 267 male patients, 115 (43%) patients had testicular non-seminomatous germ cell tumors (NSGCT) and 152 (57%) seminomatous germ cell tumors (SGCT). Among NSGCT patients, those presenting with metastatic disease had a higher proportion of predominant (>50%) embryonal carcinoma (64% vs. 43%, respectively, P = 0.03), and lymphovascular invasion (45.8% vs. 26.6%, respectively, P = 0.03) than non-metastatic patients. Spermatogenesis was observed in 56/65 (86.2%) and 36/49 (73.5%) of non-metastatic and metastatic NSGCT patients, respectively (P = 0.09). On semen analysis, severe oligospermia (<5 million/ml) was more common in metastatic than in non-metastatic NSGCT (26.5% vs. 8.3%, respectively, P = 0.04). On multivariate analysis, predominant embryonal carcinoma and lack of spermatogenesis in pathological specimens were associated with metastatic disease.ConclusionThe absence of spermatogenesis and a high proportion of embryonal carcinoma was associated with advanced disease in patients with NSGCT. Whether it may also translate as a predictor of oncologic outcome needs further evaluation.     

低压回肠“b”状膀胱成形术

探讨解决膀胱癌患者膀胱全切后的贮尿和排尿问题的方法。方法利用带蒂回肠段施行低压回肠“ｂ”状膀胱成形术１６例。结果术后新膀胱贮尿功能良好,经尿道排尿。通过残余尿测定,实验室及影像学检查,无水,电解质代谢紊乱,无输尿管返流,无尿失禁及肾功能损害,术后患者生活质量较高。     

Management and outcome of paediatric testicular tumours – A 20 year experience

Objective: To report a 20-year experience highlighting management and outcome(s) of paediatric testicular tumours.Patients and Methods: All males (< 19 years) with an index diagnosis of testicular tumours during the era(s) 1998–2018 in North West England were identified. Data were collected regarding age at diagnosis, disease stage, surgical operations, tumour biology and outcome(s).Results: A total of 34 male patients were identified. Median age at primary diagnosis was 94 months (range: 0–229 months). Eighteen tumours were benign and 16 malignant. Twenty cases (59%) were recorded in pre pubertal children and 14 (41%) in post pubertal males . In the pre pubertal group (0–11 years) - 15 cases of germ cell tumours (unrelated to germ cell neoplasia in situ – non-GCNIS derived) were recorded, including six yolk sac lesions, eight teratomas and one mixed teratoma/yolk sac tumour (pre-pubertal type). Four males with sex cord-stromal tumours included one juvenile granulosa cell tumour, two Sertoli cell tumours and one Leydig cell tumour. One miscellaneous type tumour notably a papillary cyst adenoma was also identified. In the post pubertal male cohort (>12 years) (n = 14) – four non-GCNIS derived tumours were identified (3 epidermoid cysts and one teratoma), eight cases of germ cell tumour derived from germ cell neoplasia in situ (GCNIS derived) included one teratoma, six with mixed germ cell tumours and one embryonal carcinoma. Two males had sex cord stromal tumours: (Leydig cell and granulosa cell biology). Twenty-eight patients underwent high radical inguinal orchidectomy(s) with one male also requiring retroperitoneal surgery to clear distant locoregional disease and a further single case thoracotomy and metastasectomy. Six patients had lesions suitable for ‘testicular sparing’ surgery. Six patients had metastatic disease at presentation (18%). Overall study survival was 97%. A single fatality occurred in an adolescent male with a mixed GCT harbouring liver, lung and para-aortic disease who died 48 months after initiating treatment.Conclusion: We highlight one of the largest study series of paediatric testicular tumours in the UK and Europe. Non-GCNIS derived tumours accounted for the most common tumour biology (56%). Survival for paediatric testicular tumours is reassuringly generally excellent. Delayed presentation however with a malignant testicular tumour may be associated with poor outcome(s).     

超声引导下胃肠道病变穿刺活检

目的探讨超声引导下胃肠道病变穿刺活检的临床应用价值。方法对30例经肠镜、CT或MRI检查发现但未能明确诊断的胃肠道病变(胃来源2例、小肠4例、结肠4例、直肠18例、肛管2例)进行超声引导下穿刺活检,总结活检方法、成功率及相关并发症。结果 30例中,经腹穿刺10例,经直肠穿刺16例,经肛周穿刺4例。标本取材满意29例,目标病灶穿刺成功率96.67%(29/30)。29例取材成功者中,活检病理提示良性病变11例,恶性病变18例,其中7例手术切除,6例活检病理与手术病理相符,1例活检病理不能鉴别未分化癌与间皮瘤,手术病理证实为未分化癌,其余病例与随访结果相符。穿刺后随访1~18个月,所有患者均未出现穿刺相关并发症。结论对于胃肠道病变,尤其是内镜活检困难或无效的病变,超声引导穿刺活检是安全、有效的诊断方法。     

Prepubertal testicular and paratesticular tumors in China: a single-center experience over a 10-year period

ObjectivePrepubertal testicular tumors are rare and fundamentally distinct from adult testicular tumors. We reviewed our 11-year experience in a single medical center of China.Material and MethodsThis study reports the clinical characteristics, histopathologic diagnosis, treatment methods, and outcome in a series of 63 prepubertal boys who were treated between 1997 and 2008.ResultsA total of 63 primary prepubertal testicular and paratesticular tumors were identified. The median age at presentation was 11 months. Of these tumors, 27 (42.9%) were mature teratomas, 5 (7.9%) were immature teratomas, 21 (33.3%) were yolk sac tumors, 4 (6.3%) were epidermoid cyst, 2 (3.2%) were Leydig cell tumors, 1 (1.6%) was a mixed malignant germ cell tumor, and 3 (4.8%) were paratesticular tumors. The most common clinical presentation (95.2%) was a painless scrotal mass or swelling. Forty-eight tumors were treated with radical inguinal orchiectomy, and 15, with a testis-sparing procedure. Follow-up was available in 59 cases, range from 4 to 128 months (median, 50 months). One patient with yolk sac tumor had recurrence and progression to metastasis at the end of 4 months after surgery. Other patients were disease free at last follow-up.ConclusionsMost of the prepubertal testicular lesions were benign, and the most common histologic subtype was teratoma. Our experience with testis-sparing procedures supports the current trends that less invasive treatment should be performed for benign lesions. This study confirms the excellent cure rates obtained in children with prepubertal testicular tumors.     

Radial scars diagnosed on breast core biopsy: Frequency of atypia and carcinoma on excision and implications for management

AimsThe risk of finding carcinoma in excisions following a core needle biopsy diagnosis of radial scar is not well defined and clinical management is variable.The aim of this study is to determine the frequency of high-risk lesions, ductal carcinoma in situ, and invasive carcinoma in excisions following a core biopsy diagnosis of radial scar.Methods and resultsDedicated breast pathologists and radiologists correlated the histologic and radiologic findings and categorized radial scars as the target lesion or an incidental finding. High-risk lesions were defined as atypical hyperplasia or classical lobular carcinoma in situ.Of the 79 radial scars identified over a 14-year period, 22 were associated with atypia or carcinoma in the core biopsy. Thirty-seven (37) of the 57 benign radial scars underwent excision with benign findings in 30 (81%), high-risk lesions in six (16%), and flat epithelial atypia in one (3%). There were no upgrades to carcinoma. One patient with a benign radial scar developed a 3-mm focus of intermediate-grade estrogen receptor-positive ductal carcinoma in situ in the same quadrant of the ipsilateral breast 72 months after excision. One patient with an incidental un-excised benign radial scar was diagnosed with ductal carcinoma in situ at a separate site of suspicious calcifications.ConclusionsIn this series, none of the benign radial scars was upgraded to carcinoma. Radial scar was the targeted lesion in all cases with high-risk lesions on excision. Surgical excision may not be mandatory for patients with benign incidental radial scars on core biopsy.     

The role of fine-needle aspiration and intraoperative frozen section in the surgical management of solitary thyroid nodules

Purpose: We evaluated the role of intraoperative frozen section (FS) in the surgical management of solitary thyroid nodules, as its true value is a subject of some controversy. Methods: We reviewed the records of 206 consecutive patients operated on for solitary thyroid nodules. All patients had undergone both preoperative fine-needle aspiration (FNA) and intraoperative FS. The diagnostic findings of FNA cytology and FS histology were compared with the final histological results. Results: There were 61 patients with cancer and 145 with various benign conditions. The sensitivity and specificity of FNA were 78.1% and 96.5%, respectively, demonstrating an overall accuracy of 91.3%. The sensitivity, specificity, and accuracy rates for FS were 83.3%, 95.2%, and 91.7%, respectively. FS altered the operative decision in 14 patients, but correctly so in only 8 patients. Correlated with FNA cytology, the yield of FS in assisting in the intraoperative decision making was 1.8%, 3.4%, and 5.2% for benign, malignant, and suspicious cytology, respectively. Conclusions: When the results of FNA and FS are interpreted as either benign or malignant, both are highly accurate predictors of the pathological nature of the nodule. However, the findings of the present study do not support the use of FS in the surgical management of solitary thyroid nodules, regardless of FNA cytology. Received: August 27, 2001 / Accepted: March 5, 2002     

Testicular tumours in infancy and children

Introductionprepubertal testicular tumours are different from those that appear during adulthood. Traditionally, they were considered to be malignant, however benign testicular tumours are actually more frequent at this age.Materials and methodswe analysed our experience in the treatment of testicular tumours in children ≤ 13, with the intention of evaluating the use of partial orchiectomy. From 1984 to 2008, we diagnosed and treated 15 testicular tumours in children at our centre. We examined the therapeutic approach employed, underlining the possibility of testicular conservation in selected patients and we have analysed the results.Resultsthe clinical presentation in 80% of the cases was an increase in testicle size with palpable mass. We performed 4 radical orchiectomies (27%) and 11 tumourectomies (73%). All the benign lesions in the final pathological anatomy were treated with tumourectomy: four epidermoid cysts, one hemangioma, one lipoma, one fibrous hamartoma, one juvenile granulosa tumour and one splenogonadal fusion. We also successfully and conservatively treated two cases of teratoma. The cases that received radical treatment were a yolk sac tumour (Stage I), two mixed germ cell tumours and one gonadoblastoma.Conclusionsthere are more cases of benign testicular tumours than malignant tumours during puberty. In the event of a palpable testicular mass with negative tumour markers, conservative treatment by means of a tumourectomy may be considered. However, the lesion must be removed completely to prevent recurrence.     

Hepatic Resection of Metastatic Testicular Carcinoma: A Further Update

Background: The goal of this study was to update the multidisciplinary review of patients who underwent resection of hepatic metastases of nonseminomatous germ cell esticular carcinoma at the Indiana University Medical Center.Methods: The study involved retrospective chart review for 57 patients who underwent hepatic resection for treatment of metastatic nonseminomatous testicular carcinoma between June 1974 and May 1996. Patients were categorized ccording to the worst postchemotherapy pathologic diagnosis.Results: Chemotherapy has been highly effective in curing testicular carcinoma. However, even with platinum-based hemotherapy, one-third of patients either do not achieve complete cures or experience relapses. Since 1965, only 57 of the 2219 patients who underwent postchemotherapy retroperitoneal lymph node dissections for treatment of testicular carcinoma at our center underwent hepatic resection for treatment of metastatic disease. Because teratomas have the propensity to degenerate into sarcomas and can cause symptoms resulting from compression, these lesions must be resected to achieve cures. In addition, the only chance for survival for patients with active disease but normal serum marker levels is with complete resection of the tumor burden.Conclusions: We conclude that hepatic resection for treatment of metastatic testicular carcinoma is safe and efficacious for all patients except those with elevated marker levels after preoperative chemotherapy.     

Is frozen shoulder completely resolved at 2 years after the onset of disease?

BackgroundAlthough numerous studies have suggested that frozen shoulder (FS) is a self-limiting disease with most patients recovering within 2 years, its long-term outcome is still controversial. The aims of this study were to evaluate the clinical outcomes after conservative treatment for FS and to determine the predictors of its clinical outcome.MethodsThis study included 234 shoulders of 215 patients who received conservative treatment for FS. The mean follow-up period was 41.8 months (range 27–117 months). Initial evaluation included demographics, detailed medical history, and clinical assessments of shoulder status. Questionnaires, which included the Visual Analogue Scale (VAS) pain score, American Shoulder and Elbow Surgeons (ASES) score, Subjective Shoulder Value (SSV) and satisfaction grading for the current shoulder status were assessed at the final follow-up.ResultsThe mean VAS pain score, ASES score, and SSV significantly improved from 6.7, 37.0, and 40.1% at the time of initial evaluation to 1.5, 87.6, and 85.0% at the final follow-up evaluation (all p < 0.001). According to satisfaction grading, the shoulder status at the final follow-up was very satisfied in 101 shoulders (43.2%), satisfied in 68 (29.1%), fair in 37 (15.8%), unsatisfied in 20 (8.5%), and very unsatisfied in 8 (3.4%). Univariate analysis revealed that gender, diabetes, simultaneous bilateral involvement, overall bilateral involvement and duration of symptoms were associated with clinical outcomes at the final follow-up. Multivariate analysis revealed that duration of symptoms (p = 0.002) was an independent risk factor for unsuccessful outcome.ConclusionsAt the mean follow-up period of 41.8 months, 72.3% of patients revealed subjective satisfaction for the current shoulder status. Duration of symptoms was an independent risk factor for poor prognosis.     

Perinatal testicular torsion: The clear cut,the controversial,and the "quiet" scenarios

BackgroundPerinatal testicular torsion (PTT) is a catastrophic event that occurs in utero or up to 30 days postnatally, with testicular loss being the most common outcome.ObjectiveTo assess clinical evaluation, surgical management and clinical outcomes in patients with PTT in a quaternary referral pediatric center, to determine testicular salvageability and propose future management options.MethodsWe retrospectively reviewed a cohort of males born outside the quaternary center with a diagnosis of PTT, from May 2000 to July 2020. Data collection included mode of delivery, gestational age, birth weight, testicular examination at birth, clinical presentation, ultrasound results at diagnosis, surgical management and findings, perioperative complications, and follow-up.Results62 patients, including 2 patients with bilateral asynchronous PTT, were identified. Median (IQR) gestational age and birth weight were 39 (38–39.4) weeks and 3.4 (3.1–3.72) kg, respectively. Abnormal testicular examination at birth was found in 69% (Table 1). Doppler ultrasound was performed in all but 1 patient. 59 patients underwent surgery, 21 within 4 h, with bilateral exploration in 44 cases. Affected and non-affected testicles were explored in 76% and 98% of cases, respectively. 3 "nubbins" were found, of which 2 were excised. 3 nonsurgical complications were identified. During a median (IQR) follow-up of 3 (3–3) months, 63 testicles were removed or found to be non-functional, with compensatory hypertrophy in 38% of patients.ConclusionGiven that 3% of our patients presented with asynchronous bilateral PTT, as well as the safety of general anesthesia in a referral pediatric hospital, early bilateral scrotal exploration of PTT is recommended.Level of evidenceIV     

Quiste epidermoide testicular

IntroductionTesticular tumors are usually managed by radical orchiectomy because of the high incidence of malignant lesions.Epidermoid cyst of the testis is a rare benign tumor, and its differential diagnosis from malignant testicular tumors is difficult.Materials and methodsThe clinical records of seven patients who attended our hospital with testicular epidermoid cysts were reviewed.Preoperative evaluation consisted of testicular ultrasonography in 6 patients, and magnetic resonance imaging in 4 patients. A peroperative biopsy was performed in four patients.ResultsUltrasonographic appearance was specific for diagnosis of epidermoid cyst in 80% of patients. Pathological diagnosis was made in all biopsies taken during surgery.Conservative management was (tumorectomy or partial orquidectomy) performed in 6 patients (85%).ConclusionsPreoperative imaging findings, gross characteristics of the lesion, and peroperative biopsy results provide adequate information to attempt testis-sparing surgery instead of radical orchiectomy.     

Primary chemotherapy followed by a selective retroperitoneal lymphadenectomy in the management of clinical stage II testicular carcinoma: a preliminary report

In 28 patients with primary clinical stage II testicular carcinoma (retroperitoneal mass of less than 10 cm. in diameter) or persistently elevated levels of serum biomarkers after orchiectomy primary chemotherapy was administered followed by selective lymphadenectomy for patients with a persistent retroperitoneal mass. Of the patients 21 were treated with cyclophosphamide, doxorubicin, cisplatin/vinblastine and bleomycin, and 7 who were not candidates for this regimen received less aggressive chemotherapy. All 28 patients were free of disease after a mean followup of 93.6 weeks and a median of 89 weeks (range 28 to 199.5 weeks). No patient who achieved complete remission has had relapse. Of the 28 patients 1 had a seminoma and an elevated alpha-fetoprotein level, 15 had embryonal carcinoma (Dixon-Moore category II) and 12 had teratocarcinomas (Dixon-Moore category IV). Only 1 of the 15 patients with embryonal carcinoma required surgical exploration for a persistent radiographic abnormality, whereas 6 of the 12 patients with Dixon-Moore category IV tumors required surgical exploration (p less than 0.0147). This delayed approach did not increase surgical complications. Our experience with primary chemotherapy followed by selective lymphadenectomy for stage II testicular carcinoma resulted in universal survival. Only 8 of the 28 patients (29 per cent) required lymphadenectomy.     

Vacuum-assisted complete excision of solid intraductal/intracystic masses and complex cysts: Is follow-up necessary?

IntroductionManagement of complex cysts and benign intraductal/intracystic masses is controversial. The aim of this study was to determine if the complete removal of the complex cyst lesions with ultrasound-guided vacuum-assisted excision (US-VAE) is sufficient for their safe management when the histological diagnosis obtained at biopsy is benign.Subjects and methodsThis is a single institution retrospective study performed on patients who underwent breast biopsy between April 2007 and September 2013. Patients with complete removal of complex cyst lesion of a BIRADS 4 lesion by US-VAE that obtained a benign diagnosis were included. Size, morphology, histological diagnosis, and surgical or imaging follow-up of the lesions were analyzed.ResultsDuring the study period, 131 lesions met the inclusion criteria. Benign papilloma represented 32% (42/131) of the lesions; the remaining lesions had various benign diagnoses. Mean size of the solid mass or the cysts' thickest septum was 7 mm (range, 2–24). Mean imaging follow-up was 34.9 months (24–99 months) in 115 lesions. No recurrence or malignancy in the post-biopsy bed were observed during follow-up. Eleven lesions (8.4%) underwent surgery as follow-up: no cancer was found, but two lesions demonstrated atypia.ConclusionsComplex cyst lesion image completely excised with US-VAE and with a benign histology at biopsy might not require further imaging follow-up or surgery and a return to routine screening can be safely recommended. In a world where healthcare delivery and accessibility is important, elimination of unnecessary follow-ups is pertinent given its lower cost and lesser social impact.     

Lesions of the calvaria: Surgical experience with 42 patients

Background: Lesions of the calvaria (cranial vault), whether benign or malignant, are rare, and the number that require surgical attention is very limited. During a 13-year period, 42 patients ranging in age from 13 to 82 years were treated surgically at our institution for lesions involving primarily the calvaria. The patients were found to have 16 benign lesions, 21 malignant lesions, and 5 pathologically ill-defined lesions. At last follow-up, 23 patients were still alive. Methods: Criteria for choosing surgery as the preferred therapeutic modality included (a) uncertain diagnosis; (b) benign lesions with a high probability of total removal; 3) malignant lesions that represented theonly residue of a systemic malignancy that was in remission; or (d) lesions that were rapidly enlarging, were causing significant symptoms, or were unresponsive to radiation or chemotherapy. Results: Preoperative needle biopsy was useful for some patients in establishing a definitive diagnosis and in providing the basis for the most effective treatment strategy. Most lesions were treated with either craniectomy alone (n=16) or with craniectomy and cranioplasty (n=26). Six of the 42 patients had postoperative complications. There was no operative mortality. Conclusion: This review of a series of patients with calvarial lesions provides an outline of the overall diagnostic workup and management of this unique patient population.     

Laparoscopic staged management of high intrabdominal testis: A prospective randomized study

ObjectiveTo prospectively compare outcomes and complications of both staged laparoscopic techniques used in management of high intrabdominal testis (IAT).Materials and MethodsForty five patients were included in the study in whom unilateral high IAT were identified and were subjected to two-stage laparoscopic orchiopexy. Patients were prospectively randomized into two groups according to laparoscopic technique in use; either two stage Fowler-Stephens laparoscopic orchiopexy (FSLO) or staged laparoscopic traction orchiopexy (SLTO).Intraoperative evaluation for the distance of the testis from the internal ring, state of the internal ring (closed or open), operative time (min), intraoperative and early postoperative complications were recorded after first stage.Surgical outcomes of both techniques included operative time, intraoperative complications, success rate, final scrotal site position, testicular size and vascularity, and these were recorded within 48h of the second stage procedure and at 6 month follow-up.ResultsStaged FSLO was performed on 25 testes. Four cases were lost during follow up. Out of these 21 cases, one child had an atrophic testis before the second stage based on previously recorded operative size. SLTO was done on 20 testes. We had 2 cases of fixation suture slippage rendering a total of 18 patients who underwent second stage operation. No patients converted from laparoscopic to open surgery.At 6 month follow-up visits, 27 testes were found on examination to have a low scrotal position, (14 in the FSLO group and 13 in the SLTO group), 9 testes in high scrotal position (5 in the FSLO group and 4 in the SLTO group). Testicular ascent occurred in one patient in each group. Testicular atrophy was identified in 3 cases among the FS group, while no case of testicular atrophy occurred in the traction group of patients (p = 0.048).ConclusionsBoth staged laparoscopic techniques had comparable success rates as regard final scrotal position for high undescended IAT in children, and were associated with no intra or post operative complications. SLTO had a better outcome as it was not associated with any testicular atrophy compared to FSLO at 6 months follow up.