Paratesticular Tumors: A Systematic Review and Proposed Risk-Based Management Algorithm.

Objective: To comprehensively review the literature on paratesticular tumors and to develop a new management algorithm.

Methods: A systematic review was conducted from 1980 to 2024 in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A search was performed on PUBMED to identify studies investigating paratesticular tumors, limited to cases >16 years of age. Data on histologic type, laterality, age, treatment, stage at presentation, imaging findings, follow-up, and outcomes were extracted.

Results: Of 1073 articles reviewed, 85 met criteria for analysis. A total of 479 cases were reviewed: 397 malignant and 82 benign. For malignant cases, the most common presentation was painless scrotal mass, while benign cases presented with a painless scrotal mass or were identified incidentally. Radiographic characteristics were compared between malignancy and benign histology. The most common malignant and benign diagnosis was liposarcoma (40%) and adenomatoid (34%), respectively. Radical orchiectomy for malignant tumors and local excision for benign tumors were the most described treatments. Important variables identified in literature were used to develop a risk-based management algorithm.

Conclusion: This first systematic review of paratesticular tumors describes clinical and radiographic characteristics stratified by malignant or benign histology. The analysis of the literature was leveraged to develop a novel management algorithm to help with clinical decision-making. OSF REGISTRY: https://doi.org/10.17605/OSF.IO/4BDUY. After extensive searching, this registry was deemed the most appropriate given that all the articles included in the analysis were non-interventional retrospective studies or case series.