Partial Orchiectomy Workup

Updated: Dec 11, 2020
  • Author: Samuel G Deem, DO; Chief Editor: Bradley Fields Schwartz, DO, FACS  more...
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Laboratory Studies

An evaluation of serum tumor markers (alpha-fetoprotein [AFP], beta-human chorionic gonadotropin [bHCG], lactate dehydrogenase [LDH], testosterone) is mandatory in the assessment of any testicular mass. If the marker levels are elevated, testicle-sparing surgery is not an option; the appropriate management is radical orchiectomy. When the marker levels are within the reference range in patients with nonpalpable testicular masses detected incidentally, open excisional biopsy can be offered.


Imaging Studies

The frequency of testicular ultrasonography performed for reasons other than evaluating a testicular mass has been increasing. Other indications for testicular ultrasonography include orchalgia, epididymitis, hydrocele, varicocele, and testicular trauma, among many other conditions. A hypoechoic area within the confines of the tunica albuginea is suspicious for testicular cancer. [10, 11] If this mass is nonpalpable, partial orchiectomy can be considered as a treatment option. [12] See the images below.

Scrotal sonogram showing a 0.5-cm X 0.6-cm, hypoec Scrotal sonogram showing a 0.5-cm X 0.6-cm, hypoechoic, parenchymal mass in the left testis of a 24-year-old man with no palpable lesions. Findings of tumor marker studies and abdominal and pelvic CT scanning were negative. He was treated with an open ultrasound-guided excisional biopsy through an inguinal incision.
Scrotal sonogram showing a 0.5-cm X 0.4-cm hypoech Scrotal sonogram showing a 0.5-cm X 0.4-cm hypoechoic parenchymal mass in the left testis of a 30-year-old man with a nonpalpable testicular mass. Tumor marker results were negative.

Further workup for a testicular mass includes an abdominal CT scanning and chest radiography.


Diagnostic Procedures

Intraoperative ultrasonography with needle localization is used at the time of surgery. Preoperative biopsy is usually not offered in order to prevent altering lymphatic drainage and patterns of lymphatic spread by creating a tract through the scrotum.


Histologic Findings

In some cases, frozen-section analysis at the time of surgery yields false-negative results. Final pathology can reveal testicular carcinoma.

In a study by Powell and Tarter (2006), 50% of patients undergoing open excisional biopsy for a nonpalpable, incidentally detected testicular mass required delayed radical orchiectomy. [13]

In a review of 8 published studies on nonpalpable, incidentally detected testicular masses, cancer was present in 32% (14 of 44) cases. [13, 14, 15, 16, 17, 18, 19, 20] All neoplasms were seminoma except one mature teratoma. This is an important finding in counseling patients, as up to 50% of final pathology specimens can reveal testicular cancer, necessitating radical orchiectomy. See the images below.

Final pathology showing a sex cord stromal tumor. Final pathology showing a sex cord stromal tumor. The testis was spared due to low malignant potential of the neoplasm.
Final pathology showing seminoma. Frozen section r Final pathology showing seminoma. Frozen section revealed a lymphocytic infiltrate with epithelioid cells consistent with granulomatous disease. Treatment was radical orchiectomy. No residual invasive seminoma was found in the orchiectomy specimen.


The following is the tumor, node, and metastases (TNM) staging system for testicular cancer, developed by the American Joint Committee on Cancer (AJCC):

Primary tumor (T)

See the list below:

  • pTX - Primary tumor cannot be assessed

  • pT0 - No evidence of primary tumor

  • pTis - Intratubular germ cell neoplasia [21]

  • pT1 - Tumor limited to the testis and epididymis and no vascular/lymphatic invasion

  • pT2 - Tumor limited to the testis and epididymis with vascular/lymphatic invasion or tumor extending through the tunica albuginea with involvement of tunica vaginalis

  • pT3 - Tumor invades the spermatic cord with or without vascular/lymphatic invasion

  • pT4 - Tumor invades the scrotum with or without vascular/lymphatic invasion

Pathologic regional lymph nodes (N)

See the list below:

  • pN0 - No regional lymph node metastasis

  • pN1 - Lymph node mass, 2 cm or less in greatest dimension and 6 or fewer positive nodes, none larger than 2 cm in greatest dimension

  • pN2 - Lymph node mass, more than 2 cm but not more than 5 cm in greatest dimension; more than 5 nodes positive, none larger than 5 cm; evidence of extranodal extension of tumor

  • pN3 - Lymph node mass more than 5 cm in greatest dimension

Distant metastases (M)

See the list below:

  • M0 - No evidence of distant metastases

  • M1 - Nonregional nodal or pulmonary metastases

  • M2 - Nonpulmonary visceral masses