PURPOSE:Leydig cell tumors (LCTs) are rare, usually benign testicular tumors for which frozen section examination is commonly recommended during testis-sparing surgery (TSS). We report a 27-year single-center experience, emphasizing the role of imaging for conservative surgery decision-making. It shows our experience using expert radiology assessment to direct TSS without frozen section examination. MATERIALS AND METHODS:In this retrospective observational study, we reviewed our institutional database of testicular tumors treated between 1998 and 2025. Patients with histologically confirmed LCTs were included. Clinical presentation, hormonal profile, imaging characteristics, surgery type, and intraoperative frozen section use were analyzed. RESULTS:Among 481 testicular tumors, 68 (14.14%) were LCTs. Within the histologically confirmed LCTs cohort, preoperative expert radiology assessment achieved 97% (66/68) concordance with the final pathology. Partial orchiectomy was performed in 62 cases (91.18%), total orchiectomy in 6 (8.82%). Median age was 36 years. Median follow-up was 75 months. No malignant LCTs were observed. All patients remained in complete remission. The most common reasons for consultation were infertility (n=41, 60.29%) where systematic ultrasound screening discovered the lesion, gynecomastia (n=4, 5.88%), Klinefelter syndrome work-up (n=4, 5.88%; 2 additional cases identified within the infertility group, total n=6) and palpable nodule (n=4, 5.88%). Median ultrasound tumor size was 7 mm (range: 2 to 32 mm). CONCLUSIONS:Radiological characteristics effectively differentiated LCTs, suggesting that direct TSS without frozen section examination might be feasible when expert radiological evaluation is available. Our findings reflect radiology-pathology concordance within histologically confirmed LCTs rather than diagnostic accuracy in an unselected population. This approach optimizes surgical workflow, preserves endocrine function and fertility. No recurrence was observed. Frozen section examination should be maintained where expert radiology consultation is unavailable or diagnostic uncertainty exists. Prospective validation is required before omitting frozen section examination outside expert centers.

Introduction: Andrology and urogenital reconstruction are emerging disciplines in French urology. The aim of our study was to evaluate the evolution of andrological surgical procedures over the period 2013-2022 using national data. Materials and methods: We collected national common classification of medical acts (CCAM) coding data for all procedures involving andrological surgery from the Scansant & eacute; internet platform set up by the Technical Agency for Information on Hospitalisation, which collects prospectively from healthcare structures all procedures coded according to CCAM coding. All surgical procedures in andrology were selected. The inclusion period extended from 2013 to 2022. Results: In 10 years, the number of vasectomies has increased tenfold, with 29,890 cases in 2022. Vaso-vasostomies remain marginal, with 80 cases per year. Trans-identity surgeries are rising sharply. Vaginoplasties have multiplied by 4 (333 in 2022) and masculinising surgeries have multiplied by 10 (234 in 2022). Penile prosthesis surgery has increased slightly over 10 years. The number of testicular biopsies has remained stable over time, as has the number of surgeries for curvature of the penis. Conclusion: Two andrological surgeries are showing very strong growth: vasectomy and transgender surgery. The emergence of these 2 activities is linked to societal aspirations. Urologists need to be trained to meet this demand. Niveau de preuve: Grade 4.

Objective: AI-derived language models are booming, and their place in medicine is undefined. The aim of our study is to compare responses to andrology clinical cases, between chatbots and andrologists, to assess the reliability of these technologies.Material and method: We analyzed the responses of 32 experts, 18 residents and three chatbots (ChatGPT v3.5, v4 and Bard) to 25 andrology clinical cases. Responses were assessed on a Likert scale ranging from 0 to 2 for each question (0-false response or no response; 1-partially correct response, 2- correct response), on the basis of the latest national or, in the absence of such, international recommendations. We compared the averages obtained for all cases by the different groups.Results: Experts obtained a higher mean score (m=11/12.4 σ=1.4) than ChatGPT v4 (m=10.7/12.4 σ=2.2, p = 0.6475), ChatGPT v3.5 (m=9.5/12.4 σ=2.1, p = 0.0062) and Bard (m=7.2/12.4 σ=3.3, p < 0.0001). Residents obtained a mean score (m=9.4/12.4 σ=1.7) higher than Bard (m=7.2/12.4 σ=3.3, p = 0.0053) but lower than ChatGPT v3.5 (m=9.5/12.4 σ=2.1, p = 0.8393) and v4 (m=10.7/12.4 σ=2.2, p = 0.0183) and experts (m=11.0/12.4 σ=1.4,p=0.0009). ChatGPT v4 performance (m=10.7 σ=2.2) was better than ChatGPT v3.5 (m=9.5, σ=2.1, p = 0.0476) and Bard performance (m=7.2 σ=3.3, p < 0.0001).Conclusion: The use of chatbots in medicine could be relevant. More studies are needed to integrate them into clinical practice.Level of evidence 4

OBJECTIVES:An increasing number of incidental testicular tumors are diagnosed in patients during infertility workup. The aim of this study was to evaluate the accuracy of frozen section examination (FSE) for the management of these tumors.METHODS:We retrospectively studied a series of 46 testicular tumors diagnosed during exploration for infertility from 2000 to 2019 and submitted for FSE.RESULTS:A diagnosis of malignancy was made in 23 cases on both gross examination (yellow-white or cream-colored nodules for seminomas) and FSE, then confirmed on final diagnosis in 22 of the cases. One seminoma reported on FSE was revised as being a Leydig cell tumor. The 23 other lesions were diagnosed as benign on FSE, including 11 Leydig cell tumors (yellow-brown nodules), 2 Leydig cell hyperplasias, and 10 whitish fibrous lesions. All Leydig cell lesions were confirmed except 1, which was reclassified as a Sertoli cell tumor. Of the 10 cases of fibrous lesions, 6 were associated with malignancy.CONCLUSIONS:The high incidence of Leydig cell tumors and the accuracy of FSE for these lesions demonstrate the interest in FSE. In contrast, FSE is not reliable for fibrous lesions, and surgeons should be aware that a fibrosis result often corresponds with regressed tumors.

Gene expression in meiotic cells in the testis is characterized by intense transcriptional activity and alternative splicing. These processes are mainly controlled by RNA-binding proteins expressed strongly in germ cells. Functional impairments in any of these proteins' functions can lead to defects in meiosis and thus severe male infertility. Here, we have identified a homozygous frameshift mutation (NM_014469.4:c.301dup; p.Ser101LysfsTer29) in the RNA-binding motif protein, X-linked like 2 (RBMXL2) gene in a man with an azoospermia due to meiotic arrest. As RBMXL2 is known to be crucial for safeguarding the meiotic transcriptome in mice testes, we hypothesized that this variant leads to cryptic splice site poisoning. To determine the variant's impact on spermatogenesis, we confirmed the absence of RBMXL2 protein in the patient's testis tissue and then evidenced abnormal expression of several spermatogenesis proteins (e.g. meiosis-specific with coiled-coil domain) known to be altered in rbmxl2 knock-out mice with meiotic arrest. Our results indicate that RBMXL2's function in spermatogenesis is conserved in mammals. We hypothesize that deleterious variant in the RBMXL2 gene can result in male infertility and complete meiotic arrest, due to the disruption of gene expression by cryptic splice site poisoning.

Poster: ECR 2019 / C-3631 / Multiparametric US and MRI features of extratesticular lesions by: C. E. Balasa 1, M.-F. Bellin2, F. Maxwell1, B. Bresson1, G. Hindawi1, V. Izard1, S. Ferlicot3, M. Creze1, L. Rocher4; 1Paris/FR, 2Villejuif/FR, 3Kremlin Bicetre/FR, 4LE KREMLIN BICETRE/FR

Background Ultrasensitive Doppler is a novel non-invasive ultrasound (US) Doppler technique that improves sensitivity and resolution for the detection of slow flow. Purpose To investigate the feasibility of ultrasensitive Doppler (USD) for testicular disease diagnosis, using both qualitative and quantitative results. Material and Methods This prospective study was conducted in 160 successive men referred for scrotal US including B-mode and conventional Color-Doppler. A new USD sequence and algorithm dedicated to academic research were implemented into the US system. The quality criterion for a successful examination was the detection of well delineated intratesticular vessels. Qualitative USD results were described in terms of tumor vascular architecture and flow intensity for different pathologies for 41 patients. The testicular vascularization (TV), defined as a vessel's surface ratio, was quantified using customized MATLAB® software and compared in azoospermic and normal patients. Results USD was acquired successfully in 153/160 patients (95.6%). The tumor vascular architecture differed depending on the nature of the tumors. Leydig cell tumors exhibited mostly circumferential vascularization, while germ cell tumors exhibited straight vessels through the tumors, or anarchic vascular maps. USD improved the diagnostic performance of testicular Doppler US in a case of incomplete spermatic cord torsion and acute epididymitis. The reproducibility of TV measurements established an interclass correlation of 0.801. Non-Klinefelter syndrome non-obstructive azoospermia patients exhibited a lower TV compared to normal patients, to Klinefelter syndrome, and to obstructive azoospermia patients ( P < 0.002, P < 0.005, and P < 0.05, respectively). Conclusion Testicular USD can become a promising technique for improving US diagnosis of tumors, acute scrotum, and for determining infertility status.

We prospectively evaluated the performance of combined shear wave elastography (SWE) and conventional ultrasound (US) for the characterization of 89 testicular focal masses. Testes were evaluated with B-mode, color Doppler and SWE measurements, locating a region of interest on the normal and pathologic parenchyma. Thirty-seven malignant tumors (MTs), 12 burned out tumors (BOTs), 28 Leydig cell tumors (LCTs), 2 dermoid cysts and other benign lesions were included. MTs + BOTs exhibited more microliths and macrocalcifications compared with benign lesions (p < 10(-4)). LCTs manifested mostly a dominant peripheral vascularization pattern compared with other lesions. MTs + BOTs were stiffer compared with benign lesions (p < 2 x 10(-4)) but with a moderate area under the receiver operating characteristic curve (AUROC) of 80%. By focusing on LCTs versus MTs + BOTs, diagnostic performance led to an AUROC of 89% for the best stiffness parameter. For combined conventional US and SWE, the diagnostic performance to differentiate all benign lesions versus MTs + BOTs and LCTs versus MTs + BOTs increased to AUROCs of 93% and 98%, respectively. (C) 2018 World Federation for Ultrasound in Medicine & Biology. All rights reserved.

To evaluate the pathological features and recurrence of incidental testis tumours treated by partial orchiectomy in a population of infertile men.

You have accessJournal of UrologyInfertility: Therapy I1 Apr 2018PD01-10 RESULTS OF A CONSERVATIVE APPROACH TO TESTICULAR TUMOURS DISCOVERED DURING INFERTILITY MANAGEMENT Samuel Lagabrielle, Xavier Durand, Stephane Droupy, Vincent Izard, François Marcelli, Eric Huyghe, Jean-Marie Ferriere, and Ludovic Ferretti Samuel LagabrielleSamuel Lagabrielle More articles by this author , Xavier DurandXavier Durand More articles by this author , Stephane DroupyStephane Droupy More articles by this author , Vincent IzardVincent Izard More articles by this author , François MarcelliFrançois Marcelli More articles by this author , Eric HuygheEric Huyghe More articles by this author , Jean-Marie FerriereJean-Marie Ferriere More articles by this author , and Ludovic FerrettiLudovic Ferretti More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.223AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Testicular tumors discovered during systematic infertility workup are often small and non-palpable. A conservative approach so as to spare healthy testis parenchyma in this population should not be a substitute for the oncological principles. This study aimed to evaluate the pathological features of the testis tumours and the sparing surgery results on infertile men. METHODS We retrospectively pooled, from 4 andrology referral centers, 32 patients diagnosed with testis mass during regular infertility workup and who underwent a testis sparing surgery (TSS). Patients included were of all ages and consulted for infertility issues with an impaired sperm analysis. The regular infertility workup included a physical examination, a testis ultrasound and a blood test for sex hormones. The TSS was done in accordance to the oncological principles. A frozen section examination (FSE) was also sent to pathology during the procedures. RESULTS Mean age was 36 (IQR 32 – 37). Half of the patients had azoospermia (16/32) and the other half suffered from oligo-astheno-teratospermia. The mean largest tumoral diameter measured on the ultrasound was 8.5 (IQR 5 – 10). A total of 25% (8/32) of patients had a malignant tumour (seminoma 7/32, 22%; teratoma 1/32, 3%) and 75% (24/32) had a benign lesion (Leydig cell tumour 23/32, 72%; scar tissue 1/32, 3%). The FSE exhibited a positive predictive value (PPV) of 100% and a sensitivity of 43% for the detection of malignant lesions. Globally, the FSE matched the final pathology in 75% of the cases. Of the 8/32 patients (25%) with a malignant tumor, 6 underwent a complementary total orchiectomy and 2 had an additional radiotherapy. With a mean follow up of 26.1 months (IQR 8 – 31.3), one patient (3%) had an homolateral recurrence, which was a Leydig cell tumour. Not a single patient developed metastasis. One patient fathered a child (3%). CONCLUSIONS In this multicentre study, 3/4 of the tumours randomly discovered during infertility management were of a benign pathology. The FSE for the detection of a malignant contingent did not seem fully reliable but an orchiectomy may safely still be performed after the TSS. Thus, a conservative approach to testicular tumours discovered during infertility management could be proposed from the get go. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e63 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Samuel Lagabrielle More articles by this author Xavier Durand More articles by this author Stephane Droupy More articles by this author Vincent Izard More articles by this author François Marcelli More articles by this author Eric Huyghe More articles by this author Jean-Marie Ferriere More articles by this author Ludovic Ferretti More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Despite progress in human reproductive biology, the cause of male infertility often remains unknown, due to the lack of appropriate and convenient in vitro models of meiosis. Induced pluripotent stem cells (iPSCs) derived from the cells of infertile patients could provide a gold standard model for generating primordial germ cells and studying their development and the process of spermatogenesis. We report the characterization of a complex chromosomal rearrangement (CCR) in an azoospermic patient, and the successful generation of specific-iPSCs from PBMC-derived erythroblasts. The CCR was characterized by karyotype, fluorescence in situ hybridization and oligonucleotide-based array-comparative genomic hybridization. The CCR included five breakpoints and was caused by the inverted insertion of a chromosome 12 segment into the short arm of one chromosome 7 and a pericentric inversion of the structurally rearranged chromosome 12. Gene mapping of the breakpoints led to the identification of a candidate gene, SYCP3. Erythroblasts from the patient were reprogrammed with Sendai virus vectors to generate iPSCs. We assessed iPSC pluripotency by RT-PCR, immunofluorescence staining and teratoma induction. The generation of specific-iPSCs from patients with a CCR provides a valuable in vitro genetic model for studying the mechanisms by which chromosomal abnormalities alter meiosis and germ cell development.

OBJECTIVE To assess sperm quality as a function of the sampling site (testis or epididymis) in obstructive azoospermia (OA).MATERIALS AND METHODS DNA fragmentation rates in spermatozoa sampled from the testis and epididymis (from patients with different etiologies of OA) were assessed in a dUTP nick-end labeling assay.RESULTS Twenty-one OA patients were included: 5 had congenital bilateral absence of the vas deferens, 8 had genital tract infections, and 8 had idiopathic OA. A total of 8506 spermatozoa sampled from the testis, 18,358 sampled from the caput epididymis, and 18,881 sampled from the corpus/cauda epididymis were assessed. For each patient, spermatozoa from the testis had a lower overall DNA fragmentation rate (6.71% +/- 0.75 in average) than epididymal spermatozoa from the caput (14.86% +/- 1.89 in average; P = .0007) or the corpus/cauda (32.61% +/- 3.11 in average; P < .0001). The DNA fragmentation rates did not differ significantly as a function of the etiology of OA. In this small series, all deliveries were obtained with sperm samples with a low DNA fragmentation rate and delivery rates tended to be higher when testicular sperm (rather than epididymal sperm) was used (35.7% vs 12.1%, respectively; P = .06).CONCLUSION Our data argue in favor of using testicular sperm (rather than epididymal sperm) for patients with obstructive azoospermia. (C) 2016 Elsevier Inc.

Our aim in the study described here was to prospectively establish the feasibility of using and reproducibility of testicular shear-wave elastography in the assessment of testicular stiffness in 62 normal patients and 539 infertile men with obstructive azoospermia (OA), non-Klinefelter syndrome non-obstructive azoospermia (non-KS NOA), Klinefelter syndrome NOA (KS NOA), oligoasthenoteratozoospermia (OAT) or a left varicocele. The feasibility rate was 96.9%, with an intra-class correlation coefficient of 0.85 (95% confidence interval: 0.83-0.88). Median stiffness (interquartile range) values were 2.4 kPa (2.0, 2.9), 2.1 kPa (1.8, 2.5), 2.4 kPa (2.0, 2.7), 2.0 kPa (1.7, 2.4), 2.6 kPa (2, 3.2) and 2.2 kPa (1.8, 2.6) for men with a normal testis (n = 108), OAT (n = 689), OA (n = 119), non-KS NOA (n = 183), KS NOA (n = 70) and varicocele (n = 132), respectively. Testicular shear wave elastography is a feasible and reproducible technique. A significant positive association was found between stiffness and testis volume (p = 0.001). Testicular stiffness was higher in OA than in non-KS NOA populations (p = 1.e-10) and in KS NOA than in NOA populations (p = 2.0e-8), but the substantial number of overlapping values limited the clinical impact. (C) 2016 World Federation for Ultrasound in Medicine & Biology.

The publisher regrets that the first name and surname of Dr. El Sanharawi have not been identified properly. The first name should have been identified as Imane and the surname as El Sanharawi. The publisher would like to apologise for any inconvenience caused. Non-palpable incidentally found testicular tumors: Differentiation between benign, malignant, and burned-out tumors using dynamic contrast-enhanced MRIEuropean Journal of RadiologyVol. 85Issue 11PreviewTo evaluate qualitative, semi-quantitative, and quantitative parameters obtained by dynamic contrast-enhanced (DCE)-MRI for the characterization of histologically proven, non-palpable, incidentally found intratesticular tumors. Full-Text PDF

OBJECTIVETo assess the colour Doppler and ultrasound features of testicular Leydig cell tumours (LCTs) in a population of 38 surgically proven lesions.METHODSFrom August 2008 to March 2015, we retrospectively included 38 surgically proven LCTs in 36 patients. Clinical data, scrotal colour Doppler, B-mode ultrasound and videos images were reviewed for each patient. The volume, echotexture of the testis, size, shape, echogenicity and the vascularization pattern of the lesion were evaluated. The tumour margins were categorized as either smooth or lobulated. The vascularization was classified as intense, moderate or without any hypervascularization. We defined the vascularization pattern groups as central, peripheral and mixed (the latter meaning both central and peripheral).RESULTS26 patients were referred for infertility [5 patients were subsequently diagnosed with Klinefelter syndrome (KS) and 5 patients with cryptorchidism]. 28 patients underwent testis-sparing surgery, while 8 patients underwent a radical orchiectomy. The LCTs were mostly infracentimetric (68.4%), with a median size of 7.0 mm (ranging from 4.0 to 11 mm). 50% of the lesions had lobulated margins, and these were significantly larger than the smooth lesions (p < 0.05). The content of the lesions was markedly homogeneous and hypoechoic. All lesions had sharp demarcations from the adjacent pulp. 36/38 lesions exhibited moderate-to-intense hypervascularization, with a mixed intrinsic and peripheral rim pattern. Larger lesions were more hypervascularized (p < 0.05). LCTs in patients with KS had atypical features.CONCLUSIONTypical sporadic LCTs appeared as isolated hypoechoic, infracentimetric masses, with a clear demarcation from the adjacent pulp. They presented intrinsic and peripheral rim hypervascularization.ADVANCES IN KNOWLEDGEBy undertaking the largest imaging series of LCT to date (to our knowledge), we reassessed the typical sonographical aspects of LCTs, so as to provide guidance in regard to opting for testis-sparing surgery and for follow-up. LCTs present both intrinsic and rim vascularization detectable by colour Doppler ultrasound. Intrinsic vascularization and lobulated margins are common findings in testicular LCTs.

Objective: To compare the testicular Color Doppler ultrasound (US), hormone levels, and histological results from 67 infertile men with Klinefelter syndrome (KS), vs. 66 non-KS non-obstructive azoospermic men.Methods: Scrotal US images were collected from 67 infertile KS and 66 non-obstructive, non-KS azoospermic men. The testis volume, echotexture, vascularity, and microliths were evaluated and graded. We defined the following echo pattern alteration groups: normal, striated, coarse, and measurable nodules. The vascularization was classified as low, normal, moderate, or strong. Testosterone, follicle-stimulating hormone, luteinizing hormone, and inhibin B levels were determined. Large testicular nodules were removed. A testicular biopsy and sperm extraction was performed in 18 of the KS, and all of the 66 non-KS men.Results: The mean testis volume was low in the KS, compared to the non-KS patients: i.e., 2 vs. 8 mL (P < 0.0001). The distributions in the echotexture groups differed markedly, with coarse or nodular patterns in the KS men, and normal/striated patterns in the control patients (P < 0.0001). The vascularization and microlithiasis grades were higher in the KS patients than the control men (P < 0.0001 and P < 0.001, respectively). All of the nodules removed from the KS patients were benign Leydig cell tumors, and all of the biopsies showed marked Leydig cell hyperplasia, with spermatogenesis in only two patients. The non-KS biopsies were predominantly Sertoli cell-only syndrome.Conclusions: Small testes, with a coarse or nodular echotexture, hypervascularization, and microlithiasis are associated with KS. The KS nodules were benign Leydig cell tumors/hyperplasias.

Multiparametric testicular ultrasound and magnetic resonance imaging (MRI) findings were analyzed in a series of 10 infertile asymptomatic men presenting with pathologically confirmed burned-out testicular tumors. Color/power Doppler ultrasound (CDUS), shear wave elastography (SWE), contrast-enhanced ultrasonography (CEUS), and MRI were performed on 10, 5, 6, and 7 patients, respectively. All lesions appeared as a hypoechoic and hypovascular nodular area at CDUS, SWE, CEUS CDUS, and CEUS (if performed). Shear wave elastography showed a stiffer nodular area compared with the surrounding/contralateral tissues (13 versus 2 kPa); MRI revealed a well-delineated nodular area in hypointense signal on T2, a high apparent diffusion coefficient value, and a lack of enhancement.

PURPOSE:To evaluate qualitative, semi-quantitative, and quantitative parameters obtained by dynamic contrast-enhanced (DCE)-MRI for the characterization of histologically proven, non-palpable, incidentally found intratesticular tumors. MATERIALS AND METHODS:From 2006 to 2014, we included men with non-palpable, incidentally found testicular tumors on ultrasound, normal tumoral marker levels,referred for surgery. DCE-MRI data were analyzed retrospectively and independently by two radiologists blinded to the histological diagnosis. The visual enhancement patterns, time-signal intensity curves, shape of the curves (type 0-3), maximal relative enhancement (Peak), initial enhancement slope (IS), time to peak (TTP), as well as transfer constants Ktrans and Kep were compared between the tumors. The interobserver correlation was evaluated. Receiver Operating Characteristic (ROC) curves and areas under the curve (AUC) were extracted. RESULTS:Thirty-one patients (mean age of 37.3 years) were included. Tumor mean size was 1.2±0.77 cm (min=0.3cm, max=2.8cm). Regarding the histology results, three groups were defined: Twelve stromal "benign tumors" (BT) exhibited more type 2 and type 3 curves than 12 "malignant tumors" (MT) and 7 "burned-out tumors" (BOT) (p<0.0001). BT had a higher peak (96 vs. 54 and 17%), shorter TTP (215 vs. 412 and 692 sec), higher IS (73 vs. 12 and 2 arbitrary units), higher Ktrans (255 vs. 88 and 14min-1*1000) and higher Kep (554 vs. 159 and 48min-1*1000) than MT and BOT, respectively (p<0.0001, p=0.0003, p<0.0001, p<0.0001 and p<0.0001, respectively). The agreement coefficient values and the AUC extracted after gathering MT with BOT varied from 0.83 to 0.96 and from 0.868 to 0.978, respectively. CONCLUSION:DCE-MRI may assist in differentiating between benign intratesticular stromal tumors,malignant and burned-out tumors.