RESUMEN
Introduction: Small testicular lesions ≤20 mm (STL) detected by ultrasound (US), usually non-palpable, have been reported to be benign in up to 80% of cases. Thus, partial orchiectomy with or without frozen section examination and surveillance has been advocated for these kinds of lesions. We seek to report the proportion of benign lesions in testicular tumors ≤20 mm detected by US in our population and explore the predicting factors of malignancy. Material and methods: A retrospective descriptive study of orchiectomies performed for testicular tumors in patients older than 15 years between 2005 and 2019 was performed, including all patients with lesions ≤20 mm on US imaging. Results: A total of 70 patients with STL were included (mean age 34.6 ±10.8 years). Overall, 69% of the lesions were malignant while the smallest lesions (≤10 mm) showed 61% of cancer. Moreover, in the subgroup of non-palpable lesions ≤10 mm, 50% were malignant. Multifocal tumors were found in 18 subjects with a malignancy rate of 88%. There was a significant association between maximum size on US, multifocality and malignancy. Neither tumor markers nor palpability foretold a malignant lesion. A predictive model including size and multifocality was created showing a positive predictive value of 83.3%. Conclusions: US maximum size and multifocality were predictors of malignancy in STL. However, even the smallest lesions showed a 50% chance of being malignant, thus surgery with or without intraoperative biopsy is warranted in most cases.
RESUMEN
Los venenos de animales son mezclas complejas de proteínas, péptidos, enzimas y trazas de elementosno proteicos tales como carbohidratos y sales, cuya finalidad es inmovilizar la presa ycomenzar a digerirla; algunos de estos compuestos han sido aislados y caracterizados o descritoscomo toxinas letales, o se les han atribuido acciones potentes sobre proteínas específicas como, porejemplo, las involucradas en la coagulación sanguínea. Debido al descubrimiento en 1971 del péptidoque dio origen al captopril y al entendimiento de los efectos potenciales de las toxinas, se empezó aconsiderar que los venenos de animales son fuentes ricas en compuestos bioactivos, que no soloproporcionan las herramientas necesarias para descifrar los detalles moleculares de diversos procesosfisiológicos, sino que también sirven como fuente de inspiración para diseñar y desarrollaragentes terapéuticos. Este artículo expone la aplicación de nuevas alternativas terapéuticas y demodelos para el diseño de las mismas basados en algunas moléculas aisladas de venenos de serpientescon alto potencial en campos como la biomedicina y la farmacia.
Animal venoms are complex mixtures of proteins, peptides, enzymes and trace elements such ascarbohydrates and salts, which serve to immobilize preys and to begin their digestion. Some ofthese compounds have been isolated and characterized, or described as lethal toxins, while othershave powerful actions on specific proteins, such as those involved in blood coagulation. Due to thediscovery in 1971 of the peptide that gave rise to captopril and to a better understanding of thepotential effects of toxins, animal venoms started to be considered as rich sources of bioactive compounds, which not only provide the necessary toolsto decipher molecular details of various physiologicalprocesses, but also are a source of inspiration to designand develop a range of new therapeutic agents. Thisreview presents the application of new therapeuticoptions or models to design them based on certainmolecules isolated from snake venoms, with highpotential in fields such as biomedicine and pharmacy.