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Tentativa de orquidectomia parcial: a propósito de um caso clínico
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Advisor(s)
Abstract(s)
Introduc¸ão: Até ao fim dos anos 80 defendia-se que qualquer nódulo testicular suspeito devia ser
excisado com orquidectomia radical. No entanto, com o aumento do diagnóstico incidental de
massas testiculares, a maior acuidade dos exames extemporâneos e a evidência das vantagens
potenciais da orquidectomia parcial, questionou-se se seria necessário sacrificar, sempre, todo
o testículo, mesmo na presenc¸a de um testículo contralateral normal.
Caso clínico: Apresentamos o caso de um doente de 23 anos, com o diagnóstico de um nódulo
testicular com 7,5 mm, não palpável, assintomático e marcadores tumorais negativos. Foi submetido
a orquidectomia parcial guiada por ecografia e exame extemporâneo, no entanto,
por suspeita anatomopatológica de provável tumor de células germinativas, optou-se pela
totalizac¸ão da orquidectomia. O resultado histológico final foi de tumor de células de Leydig.
Tendo em conta a elevada probabilidade de lesões testiculares não palpáveis e de pequenas
dimensões serem benignas (até 80%), os efeitos da orquidectomia radical na espermatogénese,
func¸ão endócrina e estética e que não devem ser ignorados, a orquidectomia parcial é um
procedimento que, embora não seja um procedimento padrão, pode ser equacionado como
primeira abordagem em casos selecionados e em centros de referência especializados.
Introduction: Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy; however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis-sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present. Clinical Case: We present a 23-year-old patient who was asymptomatic at diagnosis of a non- -palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis-sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non-palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis- -sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers.
Introduction: Until the late 1980s, it was considered that any testicular mass, if suspicious, should be removed totally by radical orchiectomy; however, a marked increase in incidental testicular mass diagnosis, the high accuracy of diagnosis obtained from frozen section examinations, and evidence showing the potential advantages of testis-sparing surgery, threw into question the need to sacrifice the entire testis even when a normal contralateral testis was present. Clinical Case: We present a 23-year-old patient who was asymptomatic at diagnosis of a non- -palpable testicular mass with a size of approximately 7.5 mm and negative for tumor markers. He underwent a Testis-sparing surgery guided by ultrasound with frozen section examination, however, with the suspicious of Germ cell tumor, it was decided to complete the orchiectomy. The final histological results were Leydig cell tumor. Given the high likelihood of non-palpable and small testicular lesions being benign (80%), the negative impact of radical orchiectomy on spermatogenesis, cosmetic aspects, and endocrine function, impossible to ignore, Testis- -sparing surgery is a procedure that although it is not a standard procedure must be employed as the first approach in selected cases and specialized reference centers.
Description
Keywords
Orquiectomia parcial Neoplasias dos testículos
Citation
Acta Urológica Portuguesa. 2015;32(3):127-131
Publisher
Associação Portuguesa de Urologia