Mustafa Gürkan YENİCE, Ramazan UĞUR, İsmail YİĞİTBAŞI, Kamil Gökhan ŞEKER, Halil BAYTEKİN, Yavuz Onur DANACIOĞLU, Selçuk ŞAHİN, Ali İhsan TAŞÇI

Paratestiküler Kitlelerin Güncel Tanı, Tedavi ve Takip Prosedürleri

Amaç: Paratestiküler kitlelerin testis tümörleri ile pre-op ayrımı net olarak yapılamamaktadır. Genellikle testis tümörü ön tanısıyla radikal orşiektomi yapılıp nihai patoloji sonucuna göre klinik yaklaşım planlanmaktadır. Bu noktadan hareketle, klinisyenler skrotal kitle ile karşılaştıklarında, bu kitlenin testis tümörü dışında; epididimidis, tunika vaginalis, spermatik kord, yağ-kas-bağ dokusu gibi destek dokular ve embriyonel kalıntılardan da orijin alabileceğini akılda tutmalı ve tedavi yönetimini buna göre belirlemelidir..Gereç ve Yöntemler: Merkezimize 2008-2018 yılları arasında skrotal kitle ile başvurmuş, testis tümörü kabul edilerek ingüinal radikal orşiektomi yapılan 140 hastanın patoloji sonucu geriye dönük olarak incelendi. Patoloji sonucu paratestiküler kitle rapor edilen olguların preoperatif ve postoperatif verileri, klinik seyri, tedavi yönetimi literatür eşliğinde tartışıldı.Bulgular: Retrospektif olarak incelenen serimizde 13 olguda paratestiküler kitle(PTK) saptandı. Bunlardan 10 hastada Adenomatoid tümör, 2 tanesinde Rabdomiyosarkom, 1 hastada Anjiomiksoma saptandı. Sonuç: İntraskrotal yerleşimli kitlelerin köken aldığı dokunun testis kaynaklı ya da paratestiküler yapılardan mı kaynaklandığının ayırıcı tanısı sıklıkla yapılamamaktadır. Bu nedenle genelde testis tümörleri ile benzer şekilde radikal orşiektomi yapılıp kesin tanı patolojik inceleme ile konulabilmektedir. Tüm skrotal kitlelerin %2-3 ‘ünü oluşturan paratestiküler kitleler, skrotal kitle ile başvuran ve tedavi planlanması yapılan hastaların ayırıcı tanısında akla gelmesi gereken tanılar arasında kendine yer bulmalıdır. Bu konuda daha fazla sayıda hastayla ileri düzey çalışmalara ihtiyaç vardır.

Anahtar Kelimeler:

Paratestiküler kitle, Testis tümörü, Radikal orşiektomi, Rabdomiyosarkom

Current Diagnosis, Treatment and Follow-up Procedures of Paratesticular Masses

Objective:The pre-op differentiation of testicular tumors from paratesticular masses cannot be made clearly. Generally, radical orchiectomy is performed with pre-diagnosis of testicular tumor and a clinical approach is planned according to the final pathological result.When clinicians diagnose a scrotal mass, they should considered that this mass may be originated from epididymidis, tunica vaginalis, spermatic cord, fat-muscle-connective tissue, and embryonic remnants and should determine the treatment management accordingly. Materials and Methods:The pathology results of 140 patients, who were admitted to our center between 2008 and 2018 presenting scrotal mass and underwent inguinal radical orchiectomy considering as testicular tumor, were retrospectively analyzed. Preoperative and postoperative data, clinical course, and treatment management of the cases reported to be paratesticular mass by pathology were discussed in the light of the literature. Results:Paratesticular mass(PTM)was detected in 13 cases of our retrospectively analyzed series. Of these, 10 patients were found to have adenomatoid tumors(AT) 2 patients have rhabdomyosarcoma(RMS), and 1 patient angiomyxoma(AM). Conclusion:The differential diagnosis of whether intrascrotal masses are originating from testicular tissues or paratesticular structures is usually cannot be made. Therefore, radical orchiectomy is performed in the same way as testicular tumors and a definite diagnosis can be made by pathological examination. The paratesticular masses, 2-3% of the scrotal masses, should be considered in the differential diagnosis. In this regard, there is a need for studies with a higher number of series.

Keywords:

Paratesticular mass, Testicular tumor, Rhabdomyosarcoma, Radical orchiectomy,

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