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Testicular parenchymal abnormalities in Klinefelter syndrome: a question of cancer? Examination of 40 consecutive patients.

Accardo G, Vallone G, Esposito D, Barbato F, Renzullo A, Conzo G, Docimo G, Esposito K, Pasquali D - Asian J. Androl. (2015 Jan-Feb)

Bottom Line: Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm.No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up.We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Italy.

ABSTRACT
Klinefelter syndrome (KS) is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KS patients, enrolled from December 2009 to January 2013. Lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin subunit (β-HCG) serum levels assays and testicular ultrasound (US) with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance (MR) was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions.

No MeSH data available.


Related in: MedlinePlus

Longitudinal scrotal ultrasonography of a man with Klinefelter syndrome. (a) Hyper-echoic nodulation (arrow) with a diameter of 4.8 mm in the right testis which shows inhomogeneous structure and volume reduction. (b) Small spot of color Doppler in the context of the same nodulation.
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Figure 2: Longitudinal scrotal ultrasonography of a man with Klinefelter syndrome. (a) Hyper-echoic nodulation (arrow) with a diameter of 4.8 mm in the right testis which shows inhomogeneous structure and volume reduction. (b) Small spot of color Doppler in the context of the same nodulation.

Mentions: We studied several ultra-sonographic parameters, such as testicular size, echotexture, vascular pattern and the presence of micro-calcifications or other neoformations, such as testicular nodules and testicular cysts. The ultrasonography data are summarized in Table 2. In all men, testicular size was reduced according to the phenotype of the KS subject. The mean testicular volume was 2.1 ± 0.6 cm3 on the right and 2.3 ± 1.0 cm3 on the left. Twenty-seven of these (62.5%) showed regular echotexture, while in 15 subjects (37.5%), there was an irregular echotexture. Eight subjects (20%) had micro-calcifications. Of the vascular patterns, 35 patients (87.5%) had a regular vascular pattern after analysis with color Doppler, while in five subjects (2.1%) a varicocoele was found. Varicocele grade I was found in three men, and grade II in two. All clinically palpable varicocoeles were grade II. Three subjects (11.1%) showed testicular nodules < 1 cm, but none had nodules > 1 cm. Seven of the men (17.5%) showed the presence of testicular cysts. All the subjects with nodules were studied with MR, which ruled out the presence of cancer. Ultrasonography was repeated at 1, 2, and 3 years of follow-up, and no variations in ultrasonographic pattern were found in this period; the size of the nodules and the varicocoele stage were also not different from that at first detection. Figure 2a shows in panel A the longitudinal scrotal US scan of a man with KS revealing a hyper-echoic nodulation (arrow) with a diameter of 4.8 mm in the right testis. The testes present an inhomogeneous structure and volume reduction. As shown in Figure 2b, a small spot in color Doppler of the same nodulation is shown. Longitudinal scrotal ultrasonography of two representative KS subjects is depicted in Figure 3. Figure 3a shows a widespread inhomogeneous testicular structure with micro-calcifications (arrows) and small hypoecoic areola, and Figure 3b shows various testicular micro-calcifications (arrows) in an inhomogeneous testicular echo structure. We have compared biological marker levels and ultrasonographic features in KS subjects with and without a history of cryptorchidism. Eleven out of 40 KS subjects had a history of undescended testicle (28%). All subjects with undescended testicles underwent orchidopexy. The mean age at orchidopexy was 11 ± 6 years. No significant statistical differences were found between KS patents with and without cryptorchidism in any parameters evaluated (Table 1 and Figure 4).


Testicular parenchymal abnormalities in Klinefelter syndrome: a question of cancer? Examination of 40 consecutive patients.

Accardo G, Vallone G, Esposito D, Barbato F, Renzullo A, Conzo G, Docimo G, Esposito K, Pasquali D - Asian J. Androl. (2015 Jan-Feb)

Longitudinal scrotal ultrasonography of a man with Klinefelter syndrome. (a) Hyper-echoic nodulation (arrow) with a diameter of 4.8 mm in the right testis which shows inhomogeneous structure and volume reduction. (b) Small spot of color Doppler in the context of the same nodulation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4291860&req=5

Figure 2: Longitudinal scrotal ultrasonography of a man with Klinefelter syndrome. (a) Hyper-echoic nodulation (arrow) with a diameter of 4.8 mm in the right testis which shows inhomogeneous structure and volume reduction. (b) Small spot of color Doppler in the context of the same nodulation.
Mentions: We studied several ultra-sonographic parameters, such as testicular size, echotexture, vascular pattern and the presence of micro-calcifications or other neoformations, such as testicular nodules and testicular cysts. The ultrasonography data are summarized in Table 2. In all men, testicular size was reduced according to the phenotype of the KS subject. The mean testicular volume was 2.1 ± 0.6 cm3 on the right and 2.3 ± 1.0 cm3 on the left. Twenty-seven of these (62.5%) showed regular echotexture, while in 15 subjects (37.5%), there was an irregular echotexture. Eight subjects (20%) had micro-calcifications. Of the vascular patterns, 35 patients (87.5%) had a regular vascular pattern after analysis with color Doppler, while in five subjects (2.1%) a varicocoele was found. Varicocele grade I was found in three men, and grade II in two. All clinically palpable varicocoeles were grade II. Three subjects (11.1%) showed testicular nodules < 1 cm, but none had nodules > 1 cm. Seven of the men (17.5%) showed the presence of testicular cysts. All the subjects with nodules were studied with MR, which ruled out the presence of cancer. Ultrasonography was repeated at 1, 2, and 3 years of follow-up, and no variations in ultrasonographic pattern were found in this period; the size of the nodules and the varicocoele stage were also not different from that at first detection. Figure 2a shows in panel A the longitudinal scrotal US scan of a man with KS revealing a hyper-echoic nodulation (arrow) with a diameter of 4.8 mm in the right testis. The testes present an inhomogeneous structure and volume reduction. As shown in Figure 2b, a small spot in color Doppler of the same nodulation is shown. Longitudinal scrotal ultrasonography of two representative KS subjects is depicted in Figure 3. Figure 3a shows a widespread inhomogeneous testicular structure with micro-calcifications (arrows) and small hypoecoic areola, and Figure 3b shows various testicular micro-calcifications (arrows) in an inhomogeneous testicular echo structure. We have compared biological marker levels and ultrasonographic features in KS subjects with and without a history of cryptorchidism. Eleven out of 40 KS subjects had a history of undescended testicle (28%). All subjects with undescended testicles underwent orchidopexy. The mean age at orchidopexy was 11 ± 6 years. No significant statistical differences were found between KS patents with and without cryptorchidism in any parameters evaluated (Table 1 and Figure 4).

Bottom Line: Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm.No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up.We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found.

View Article: PubMed Central - PubMed

Affiliation: Department of Cardiothoracic and Respiratory Sciences, Endocrine Unit, Second University of Naples, Italy.

ABSTRACT
Klinefelter syndrome (KS) is a hypergonadotropic hypogonadism characterized by a 47, XXY karyotype. The risk of testicular cancer in KS is of interest in relation to theories about testicular cancer etiology generally; nevertheless it seems to be low. We evaluated the need for imaging and serum tumor markers for testicular cancer screening in KS. Participants were 40 consecutive KS patients, enrolled from December 2009 to January 2013. Lactate dehydrogenase (LDH), alpha-fetoprotein (AFP), and beta-human chorionic gonadotrophin subunit (β-HCG) serum levels assays and testicular ultrasound (US) with color Doppler, were carried out at study entry, after 6 months and every year for 3 years. Abdominal magnetic resonance (MR) was performed in KS when testicular US showed micro-calcifications, testicular nodules and cysts. Nearly 62% of the KS had regular testicular echotexture, 37.5% showed an irregular echotexture and 17.5% had micro-calcifications and cysts. Eighty seven percent of KS had a regular vascular pattern, 12.5% varicocele, 12.5% nodules <1 cm, but none had nodules >1 cm. MR ruled out the diagnosis of cancer in all KS with testicular micro calcifications, nodules and cysts. No significant variations in LDH, AFP, and β-HCG levels and in US pattern have been detected during follow-up. We compared serum tumor markers and US pattern between KS with and without cryptorchidism and no statistical differences were found. We did not find testicular cancer in KS, and testicular US, tumor markers and MR were, in selected cases, useful tools for correctly discriminating benign from malignant lesions.

No MeSH data available.


Related in: MedlinePlus