Organ Sparing Surgery in Stage I Testicular Sex Cord Stromal Tumours: Results of a Small Series

Emanuela Trenti*¹, Armin Pycha^1,2, Carolina D’Elia¹ , Evi Comploj^1-6 , Dorjan Huqi¹, Esther Hanspeter³, Alexander Pycha⁴, Wolfgang Horninger⁵, Salvatore M Palermo¹

Received: November 20, 2018;   Published: December 04, 2018

DOI: 10.26717/BJSTR.2018.11.002138

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Abstract

Introduction: We present a small series of patients with stage I testicular sex-cord stromal tumours (TSCST), treated with organ-sparing surgery, which confirm its feasibility and safety in selected patients.

Materials and Methods: Between 2005 and 2016 a TSCST was diagnosed in 11 patients at our department. The mean age was 46.8 years (14-83). Alpha-FP, HCG and LDH were assessed in all patients. During the operation frozen sections were request in order to choose the surgical strategy. A testis sparing surgery (TSS) was performed always in case of TSCST. A thoracic-abdominal computed tomography (CT) was performed after the surgery. The follow-up was scheduled according with the EAU guide-lines for testicular tumours.

Results: Alpha-FP, HCG and LDH were negative in all patients. The frozen sections showed a TSCST in 10 patients, which were treated with TSS. In 1 patient was performed an orchiectomy by seminoma in the frozen sections but the definitive histology showed a TSCST. The mean tumour size was 11 mm (7-40). The definitive histology showed no angio-invasion, severe nuclear atypia, margin infiltration, necrosis or high mitoses-index and the CT was negative in all cases. The mean follow-up was 43.8 months (10-108) and all patients remained free from disease.

Conclusion: TSCST represent 3-5% of all testicular tumours. A malignant behaviour is reported in about 10% of cases. Because of their low incidence their management remain controversial. The potential malignancy may be a reason to perform an orchiectomy and TSS remains an option. Our small series shows that TSS could be safely performed by TSCST in frozen sections. By one or more pathological risk factors in the definitive histology a radical surgery should always be considered. Although the good prognosis of these tumours, we point out the need of a regular follow-up.

Keywords : Sex-Cord Stromal Tumour; Testis Sparing Surgery; Leydig Cell Tumour; Sertoli Cell Tumour; Granulosa Cell Tumour

Abbreviations : TSCST: Testicular Sex-Cord Stromal Tumours; HCG: Human Chorionic-Gonadotropin; LDH: Lactate-Dehydrogenase; TSS: Testis-Sparing Surgery; CT: Computed Tomography