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 Table of Contents  
ORIGINAL ARTICLES
Year : 2022  |  Volume : 10  |  Issue : 1  |  Page : 12-15

Clinicopathological spectrum of testicular and paratesticular lesions: A retrospective study


Sukh Sagar Medical College, Jabalpur, India; RD Gardi Medical College, Ujjain, Madhya Pradesh, India

Date of Submission23-May-2022
Date of Decision25-Jun-2022
Date of Acceptance06-Jun-2022
Date of Web Publication19-Sep-2022

Correspondence Address:
Shruti Jaiswal
47/2, Joon Enclave, Phase 5, Narmada Road, Katanga, Jabalpur 482001, Madhya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/DYPJ.DYPJ_41_22

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  Abstract 

Background: Both neoplastic and non neoplastic conditions affect the testis. Although non neoplastic testicular lesions are more common, still most of the published studies are done on testicular neoplasms only. Hence the present study was undertaken to study histopathological spectrum of testicular and paratesticular lesions, their age distribution and clinical presentation. Materials and Methods: This is a retrospective study of 77 cases of orchidectomy specimens, testicular biopsies and paratesticular lesions received in the department of Pathology. Results: Non neoplastic testicular lesions were more common than neoplastic (90.1% Vs 9.8%) with majority in the second and third decade. Undescended testis comprised 46.1% of the total orchidectomy specimens followed by Torsion/Infarction testis (15.3%). None of the undescended testis showed tumour deposits unlike western countries. Majority of patients presented with empty scrotum (31.16%) and testicular/scrotal swelling (18.11%). Only 5 cases of testicular neoplasm were diagnosed during the study period amounting to only 1.42 cases per year. All were germ cell tumours (4 classic seminoma and 1 yolk sac tumour). Conclusions: Non neoplastic testicular lesions were more common than neoplastic lesions. Complete neonatal examination for testicular descent should be mandatory to avoid late presentations and future malignancies. Germ cell tumours formed the bulk of testicular tumours.

Keywords: Germ cell tumour, orchidectomy, paratesticular lesions, seminoma, torsion testis, undescended testis


How to cite this article:
Jaiswal S, Jaiswal S. Clinicopathological spectrum of testicular and paratesticular lesions: A retrospective study. D Y Patil J Health Sci 2022;10:12-5

How to cite this URL:
Jaiswal S, Jaiswal S. Clinicopathological spectrum of testicular and paratesticular lesions: A retrospective study. D Y Patil J Health Sci [serial online] 2022 [cited 2022 Oct 6];10:12-5. Available from: http://www.dypatiljhs.com/text.asp?2022/10/1/12/356516




  Introduction Top


Testis is a male gonad which is homologous with the ovary of the female genital system. Testis is a unique and important organ of the male reproductive system.[1] Testicular lesion usually present with scrotal swelling, pain in scrotum and abdominal lump. Both neoplastic and non neoplastic conditions affect the testis. Non neoplastic testicular lesions include cryptorchid (undescended) testis, testicular torsion, testicular atrophy, epidermoid cysts, infections of testis like tuberculosis, malakoplakia and vasculitis.[2]

About 1% of one-year old boys were affected with undescended testis.[3] A germ cell tumour is more likely to develop in an undescended testis than a normally placed testis. Atrophy of testis may develop from crptorchidism, infections like mumps, liver cirrhosis, radiation therapy, chemotherapy, estrogens administration, AIDS and exposure to environmental toxins.[4]

Though the testicular tumours account for less than 1% of all malignancies in males, they constitute the fourth most common cause of death from neoplasia in younger males.[5] Its incidence has been increasing in the western countries since the middle of twentieth century.[6] There is a definite geographic and racial distribution in testicular tumours and its age distribution is also distinct from other tumours.[7] The present study was undertaken to study histopathological spectrum of testicular and paratesticular lesions, their age distribution and clinical presentation from one of the tertiary care hospitals of India valley.


  Materials and Methods Top


This retrospective study was conducted in the department of pathology. There were total of 77 cases. It comprises 52 orchidectomy specimens, 20 testicular biopsies and 5 paratesticular swellings.

Age, clinical details and indications of surgery/biopsy were noted from the requisition forms obtained from the record section of the department of pathology. The corresponding histopathology slides were also retrieved and reviewed wherever required.

The specimens received were fixed in 10% neutral buffered formalin and processed by routine histo-techniques using an automated tissue processor and sections were stained with Haematoxylin and Eosin (HandE). Ziehl-Neelsen (ZN) staining was done wherever required for detection of acid fast bacilli (AFB). Immunohistochemistry (IHC) was carried out wherever necessary. Data was analysed using the SPSS Version 2.0 and presented as frequency and percentage. Testicular tumours were histologically classified according to WHO classification (2004).[8]


  Results Top


A total of 77 cases of testicular and paratesticular lesions received in the department over a period of three years and six months were included in the study. It comprises 52 orchidectomy specimens, 20 testicular biopsies and 5 paratesticular swellings.

[Table 1] shows the mode of presentation. The most common presenting complaint was empty scrotum (31.16%) followed by scrotal/testicular swelling (18.11%) and testicular pain (12.98%). About 6.41% of orchidectomies specimens received were part of hernia repair or treatment. The histopathological spectrum of orchidectomies specimen along with age distribution is summarized in [Table 2].
Table 1: Mode of presentation

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Table 2: Histopathological spectrum of orchidectomy specimens along with age distribution

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considered unsatisfactory in 5 cases (25%) as only epididymal tissue was received.

Undescended testis comprised 46.1% of the total orchidectomies received. It was followed by torsion/infarction testis (15.3%) and testicular abscess (7.6%). Atrophic testis was noted in 3.8% of orchidectomies specimens received. A single case of granulomatous orchitis and leydig cell hyperplasia was seen. AFB was not detected by ZN staining in the studied population. Orchidectomies formed part of treatment in 2 cases (3.8%) of hydrocele.

Only 5 cases (9.6%) of testicular neoplasm were diagnosed during the study period amounting to only 1.42 cases per year. All the 5 cases were germ cell tumour with age range of 15–67 years. Seminoma (n = 4, 80%) was the commonest neoplasm, followed by yolk sac tumour (n = 1, 20%). In our study, none of the orchidectomy specimens received for undescended testis showed tumour.

About 33% cases of undescended testis were noted in the 11–20 years age group and 25% in 21–30 years age group. Age range of 6 to 55 years was noted. Torsion/infarction testis was mostly observed in the second decade of life (50%) followed by third decade (37.5%). Among testicular abscess, 2 cases each were seen in the age group of 21–30 and 51–60 years. In contrast to other studies, 2 cases (50%) of classic seminoma were noted in the elderly groups of patients of 61–70 years. A single case of yolk sac tumour was noted in a 15-year-old boy.

About 98.07% (n = 51) of orchidectomies were unilateral and 1.92% (n = 1) was bilateral with 52.94% right sided and 47.05% left sided.

All the 20 testicular biopsies received were for evaluation of infertility/azoospermia. Out of these, 9 cases were in the 21-30-year age group and 11 cases in 31–40 year age group. Atrophic testis (n = 5, 25%) was the most common histopathological diagnosis followed by maturation arrest (n = 4, 20%) and sertoli cell only syndrome (n = 2, 10%). Normal spermatogenesis was seen in 2 cases (10%). About 1 case (5%) each of granulomatous orchitis and leydig cell hyperplasia was observed. Biopsy was Among paratesticular swellings, 2 cases of epididymal cyst, 1 case each of adenomatoid tumour and spermatocele were seen in 41-50-year age group. A single case of inflammatory leiomyosarcoma of epididymis was noted in a 34-year-old male which was confirmed by IHC.


  Discussion Top


Both neoplastic and non neoplastic conditions affect the testis. In our study, non neoplastic lesions of testis were more common than neoplastic lesions (90.1% vs. 9.8%) which are correlating with other Indian studies as shown in [Table 3].[5],[9],[10],[11]
Table 3: Comparison of percentage incidence of benign and malignant lesions

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We found undescended testis (46.1%) to be the most common non neoplastic lesion. However, none of the cases of undescended testis showed malignancy. A study by Sharma M et al, also showed the same results.[9] In other studies from India, inflammatory lesions and torsion testis were reported to be the most common non neoplastic lesion.

In our study, undescended testis and torsion testis was commonly noted in second decade of life which is similar to astudy by Patel MB et al.[5] Comparison of histopathological types of non neoplastic testicular lesions among other similar studies is given in [Table 4].[2],[5],[9],[12]
Table 4: Comparison of histopathological types of non neoplastic testicular lesions

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Testicular tumours were found to be rare in our study also, in concordance with the literature. All the 5 cases of neoplasm belonged to germ cell tumour category with 80% classical seminoma and 20% yolk sac tumour. Thus, amounting to only 1.42 cases per year. According to Mostofi et al, germ cell tumours constitute more than 94% of testicular tumours.[13] Studies by Moghe KV et al, and Deotra A et al. showed seminoma to be the commonest tumour in the third and fourth decades.[14],[15] In our study, we found 2 out of 4 cases of classic seminoma in 61-70-year age groups.

In this study, we found high incidence of undescended testis and its late presentation. It can be attributed to the ignorance of the rural population which the hospital caters and referral of advanced cases of malignancies to the other tertiary care hospitals of India.


  Conclusion Top


Non-neoplastic lesions of testis are more common than neoplastic leisons. All the testicular and paratesticular specimens should be thoroughly grossed and examined to rule out neoplastic leisons. Proper and complete neonatal examination for testicular descent should be mandatorily done to avoid late presentations and future malignancies. Germ cell tumours formed the bulk of testicular tumours in our study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chaurasia BD Male reproductive system. In Human Anatomy. 6th ed. New Delhi: CBS Publishers and Distribution. 2013. p. 266-96.  Back to cited text no. 1
    
2.
Reddy H, Chawda H, Dombale VD Histomorphological analysis of testicular lesions. Ind J Pathol Oncol 2016;3:558-63.  Back to cited text no. 2
    
3.
Rozanski TA, Bloom DA The undescended testis. Theory and management. Urol Clin North Am 1995;22:107-18.  Back to cited text no. 3
    
4.
Rosai J Male reproductive system. In: Rosai and Ackerman’s Surgical Pathology. 10th ed. Elsevier. 2011. p. 1335-6.  Back to cited text no. 4
    
5.
Patel MB, Goswamy HM, Parikh UR, Mehta N Histopathological study of testicular lesions. Gujarat Medical Jr 2015;70:41-6.  Back to cited text no. 5
    
6.
Bergstorm R, Adami HD, Mohner M, Zatooski W, Storm H, Ekbom A, et al. Increase in testicular cancer incidence in six European countries: A birth cohort phenomenon. J Natl Cancer Inst 1996;88:727-33.  Back to cited text no. 6
    
7.
Liu S, Wen SW, Mao Y, Mery L, Rouleau J Birth cohort effects underlying the increasing testicular cancer incidence in Canada. Can J Public Health 1999;90:176-80.  Back to cited text no. 7
    
8.
Eble JN, Sauter G, Epstein JI, Sesterheim IA Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2004.  Back to cited text no. 8
    
9.
Sharma M, Mahajan V, Suri J, Kaul KK Histopathological spectrum of testicular lesions-A retrospective study. Indian J Pathol Oncol 2017;4:437-41.  Back to cited text no. 9
    
10.
Deore KS, Patel MB, Gohli RP, Delvadiya KN, Goswami HM Histopathological analysis of testicular tumours: A 4- year experience. Int J Med Sci Public Health 2015;4:554-7.  Back to cited text no. 10
    
11.
Karki S, Bhatta RR Histopathological analysis of testicular tumors. J Pathol Nepal 2012;2:301-4.  Back to cited text no. 11
    
12.
Gaikwad SL, Patki SP Clinico-pathological study of testicular and paratesticular lesions. Int J Cont Med Res 2017;4:2454-7379.  Back to cited text no. 12
    
13.
Mostofi FK, Price EB. Jr. Tumours of the male genital system. Atlas of Tumour Pathology, Fascicle 7, Series 2. Washington, DC: Armed Forces Institute of Pathology. 1973. p. 1186-200.  Back to cited text no. 13
    
14.
Moghe KV, Agarwal RV, Junnarkar RV Tumours of the testes. Indian J Cancer 1970;7:90-7.  Back to cited text no. 14
    
15.
Deotra A, Mathur DR, Vyas MC A 18 years study of testicular tumours in Jodhpur, Western Rajasthan. J Postgrad Med 1994;40:68-70.  Back to cited text no. 15
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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