Laurence Rocher1, Aïda Ksouri2, Florian Maxwell2, Bertrand Bresson3, Ghina Hindawi2, Cristina Balasa2, Marie France Bellin3, Laurence Albiges4. 1. Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France. Electronic address: laurence.rocher@aphp.fr. 2. Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France. 3. Hôpitaux Paris Sud, service de radiologie diagnostique et interventionnelle, site Bicêtre, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin Bicêtre, France; Université Paris Sud, service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, 4, place du Gal Leclerc, 91401 Orsay cedex, France. 4. Institut Gustave-Roussy, département d'oncologie, 114, rue Edouard-Vaillaxnt, 94805 Villejuif, France.
Abstract
OBJECTIVES: Reviewing the characterization and the follow-up imaging of testicular tumors. MATERIAL AND METHODS: Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: Testicular tumors; Color Doppler ultrasound; US elastography; Magnetic resonance imaging; Contrast enhanced sonography. RESULTS: Ultrasound remains the basic exam for the tumor characterization. Among the other techniques, MRI, elastography, contrast enhanced ultrasound, although still in evaluation, will be increasingly used in the future. The frequency of benign Leydig cell tumors justifies a testicular preservation approach, through improvement of characterization, monitoring or tumorectomy. The follow-up of testicular lesions must be indicated on precise indications: follow-up of the contralateral testicle in the case of germi cell tumor, follow-up by of a supposed benign lesion, such as a small Leydig cell tumor in an infertile patient, follow-up when ultra-sound findings are not sufficiently worrying to require immediate diagnosis but which include pejorative criteria. The tumor markers and the extension screening remain systematic. CONCLUSION: The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on clinical biological data and suspected nature of the tumor at imaging.
OBJECTIVES: Reviewing the characterization and the follow-up imaging of testicular tumors. MATERIAL AND METHODS: Literature review (PubMed, Medline) of urological and radiological studies dealing with testicular tumors using keywords: Testicular tumors; Color Doppler ultrasound; US elastography; Magnetic resonance imaging; Contrast enhanced sonography. RESULTS: Ultrasound remains the basic exam for the tumor characterization. Among the other techniques, MRI, elastography, contrast enhanced ultrasound, although still in evaluation, will be increasingly used in the future. The frequency of benign Leydig cell tumors justifies a testicular preservation approach, through improvement of characterization, monitoring or tumorectomy. The follow-up of testicular lesions must be indicated on precise indications: follow-up of the contralateral testicle in the case of germi cell tumor, follow-up by of a supposed benign lesion, such as a small Leydig cell tumor in an infertile patient, follow-up when ultra-sound findings are not sufficiently worrying to require immediate diagnosis but which include pejorative criteria. The tumor markers and the extension screening remain systematic. CONCLUSION: The era of total orchiectomy for any uncertain testicular lesion is over. We try the challenge of characterization, and define management's algorithms based on clinical biological data and suspected nature of the tumor at imaging.