Epidermoid cyst of the testis: a case report

A 28-year-old man was admitted to our department with the chief complaint of a painless nodule in the left scrotal content. Physical examination revealed that a small, thumb-finger sized, hard mass with a smooth surface was palpable at the upper part of the left scrotal content. With the preoperative diagnosis of testicular tumor, the left testis was explored under ischemia. Appearance of the testis was normal and the mass was felt in the upper portion of the testis. Since the mass was suspected to be malignant, left radical orchiectomy was performed. The histological diagnosis was epidermoid cyst of the testis. Sixty-five cases of testicular epidermoid cyst including this case have been reported in the Japanese literature, and are reviewed briefly here.     

Epidermoid cyst of the testis: a report of two cases

We report two cases of epidermoid cyst of the testis. Case 1: A 57-year-old man was admitted to Osaka University Hospital with the chief complaint of a small nodule in the left scrotal content. Physical examination revealed that a little-finger tip sized hard mass was palpable at the upper part of the left testis. Left orchiectomy was performed under the diagnosis of testicular tumor. Histological diagnosis was epidermoid cyst of the testis. Case 2: A 25-year-old man was admitted to Osaka Kosei-Nenkin Hospital with the chief complaint of a nodule in the left scrotal content. Ultrasonographic examination revealed a hypoechoic lesion with echogenic rim in the left testis. Left orchiectomy was performed under the diagnosis of testicular tumor. Histological diagnosis was epidermoid cyst of the testis. In both cases, no evidence of recurrence has been noticed.     

Epidermoid cyst of the testis difficult to make a preoperative diagnosis on the echoic examination: a case report

A case of epidermoid cyst of the testis is presented. The patient was a 64-year-old man who complained of a painless mass in the left scrotum. Physical examination revealed a hen-egg sized enlargement of the left scrotal contents. The ultrasonographic appearance did not show a hyperechoic partition, which is called echogenic rim, a characteristic of this tumor on the echoic examination, and was homogeneous, almost similar to that of a normal testis. Because malignant testicular tumors could not be excluded preoperatively, excisional biopsy of the left testis was performed first. Histological diagnosis was an epidermoid cyst of the testis. As the left testis was almost completely occupied by the tumor and no normal testicular tissue was recognized, we performed orchiectomy additionally. Epidermoid cyst of the testis is a rare benign tumor that accounts for about 1 percent of all testicular tumors. It clinically resembles malignant testicular tumors, and orchiectomy is often performed for treatment. About 154 cases of testicular epidermoid cyst have been reported in the Japanese literature and are reviewed briefly here.     

A case of giant epidermoid cyst of the testis

A 79-year-old man visited our clinic with complaints of left scrotal swelling. Ultrasonography revealed solid tumor with heterogeneous echogenicity. No other abnormal findings were observed including tumor markers. However, the tumor was very large and the diagnosis of malignant testicular tumor could not be excluded. Therefore, orchiectomy was performed. Histological diagnosis was 820-gram epidermoid cyst of the left testis.     

A case of epidermoid cyst of the testis

A 32-year-old business man was admitted with the chief complaint of a right testicular mass without pain. Laboratory findings including serum AFP, HCG, and beta-HCG were within normal limits. Right high orchiectomy was performed under the diagnosis of testicular tumor. The cyst was located at the middle of the testis and was 3.5 X 3.0 X 2.0 cm in size. The cut surface of the tumor revealed a fibrous capsule with a keratin mass in it. Histological diagnosis was a benign epidermoid cyst. This case seems to be the 56th case of epidermoid cyst of the testis reported in the Japanese literature.     

Synchronous epidermoid cyst and mature teratoma of the testis: an unusual association

We describe here the first case of a synchronous epidermoid cyst and mature teratoma of the testis occurring in a young man presenting a with bilateral testicular tumor. After a clinical, biological and ultrasound evaluation, testis-sparing surgery was performed on the left testis and a total orchiectomy on the right side in accordance with oncological principles. Histopathological examination revealed a simple epidermoid cyst on the left side and a mature teratoma on the right side, following Price's criteria. No metastasis was detected, and the patient was closely followed. The patient remains disease-free and has normal postoperative testosterone levels 3 years after the surgery.     

阴囊内大体积表皮样囊肿1例报告并文献复习

目的:探讨阴囊内大体积表皮样囊肿的疾病特点,提高对阴囊内大体积表皮样囊肿的临床诊治水平。方法:回顾性分析1例阴囊内大体积表皮样囊肿患者临床资料,男,50岁,发现右侧阴囊内肿物40余年,呈进行性长大。右侧阴囊内可触及直径约为7.0cm大小椭圆形肿物,界清,质硬,触痛阴性。阴囊彩超提示右侧阴囊内有囊性肿物,大小约7.7cm×4.7cm×5.0cm,与睾丸界清。在腰硬联合麻醉下行右侧阴囊内肿物切除术。结果:术后患者预后良好。切除病变组织送病检,证实为阴囊内表皮样囊肿。结论:阴囊内表皮样囊肿是阴囊罕见的良性肿瘤,一般无明显不适,肿物可缓慢生长,目前确诊依赖于术后病检。对于阴囊内表皮样囊肿应尽早手术切除,但易复发,应长期随访。     

Fibrous pseudotumor of the vaginalis testis: report of a case

In this study, the authors have reported a case of a benign fibrous pseudotumor of the tunica vaginalis testis in a 24-year old man who was admitted with a left scrotal mass. Scrotal ultrasound and surgical investigation demonstrated the presence of a left testicular tumor; radical orchiectomy was performed by inguinal route. Microscopic examination revealed a pseudotumor of the testicular tunica vaginalis. As this is an uncommon lesion and preoperative diagnosis is difficult, unnecessary radical orchidectomy is often carried out.     

Giant Multilocular Epidermoid Cyst on the Left Buttock

BACKGROUND: Epidermoid cysts are the most common cysts of the skin. They are generally small and slow-growing and rarely reach more than 5 cm in diameter. OBJECTIVE: We present a patient with a giant multilocular epidermoid cyst. METHODS: A 75-year-old man presented with a giant, soft, painless, tumorlike mass on the left buttock that had gradually enlarged over a 12-year period. Excision of the mass from the surrounding tissue was extremely easy because of a well-defined capsule. RESULTS: The 28 x 14 x 12 cm mass was totally excised. A histopathologic examination revealed that it was an epidermoid cyst. CONCLUSION: This rare case of giant epidermoid cyst was treated successfully by local excision followed by primary closure. Dissection of the mass from the surrounding tissue was extremely easy because of a well-defined capsule.     

Epidermoid cyst of the scrotum extending into the true pelvis

A 9-year-old boy presented with an asymptomatic scrotal mass that was separate from the testes. The workup included a scrotal ultrasound scan and voiding cystourethrogram. On surgical exploration, the mass was solid, separate from the testes, and extended into the pelvis. The mass was removed, and pathologic examination revealed an epidermoid cyst. This is an uncommon scrotal lesion in boys and may represent a monodermal teratoma or abnormal closure of the median raphe. To our knowledge, this is only the second case report of an epidermoid cyst of the scrotum extending into the true pelvis.     

Case report on testicular tumors in non-twin siblings

A case report of testicular tumors in non-twin siblings is presented. A 42-year-old male was admitted to Kansai Electric Power Hospital with the complaint of swelling of the left scrotal contents. Left radical orchiectomy was performed with the diagnosis of a left testicular tumor. Histological examination revealed a seminoma of the left testis. Fifteen years later, his 43-year-old younger brother was admitted to Osaka University Hospital with the complaint of painless swelling of the left scrotal contents. Left radical orchiectomy was carried out with the diagnosis of a left testicular tumor. Histological examination showed a seminoma of the left testis. The former patient had a history of a scrotal trauma, but there was no history of orchitis or cryptorchism in these two siblings. To our knowledge, there have been reported 44 sets of testicular tumors in siblings. Eleven of these sets appeared in twins, while the other 33 sets were described in non-twin siblings. We discussed the 45 cases including our case of testicular tumors in siblings.     

Epidermoid cyst of the testis: a case of testis preservation]

A 19-year-old man complained of an asymptomatic right testicular mass. Physical examination revealed a firm, small-finger sized, mass lesion with a smooth surface in the right testis. The ultrasonographic appearance was hypoechoic and well-demarcated intratesticular lesion. All laboratory investigations, including tumor markers, were normal. The testis was explored through an inguinal incision. The mass was excised locally and the biopsy of the adjacent testicular tissue was done with gentle code clamping. The histological diagnosis was epidermoid cyst of the testis and the testicular tissue obtained was normal. About 90 cases of testicular epidermoid cyst have been reported in the Japanese literature, and are reviewed briefly here.     

A case of giant obsolete hydrocele testis

A 58-year-old man visited the urological clinic in Prefectural Tohkamachi Hospital with complaint of swelling of bilateral scrotal contents. He had no history of fever, pain or difficulty of urination. Physical examination revealed a giant mass of adult-head size in right scrotum and left inguinal hernia of fist growth. Surgical extirpation of the right scrotal mass and left inguinal herniorrhaphy was performed and the mass was diagnosed as obsolete hydrocele testis and weighed 1,600 g. The excised hydrocele sac showed marked thickening and dark brown pus amounted to about 1,400 ml, which was negative in bacterial culture. Histological examination revealed partial deposits of cholesterol and calcification in tunica vaginalis with extremely atrophic testis and destructive spermatogenesis. The findings suggested the existence of long-term infection in hydrocele testis. The etiology and pathogenesis of this disease is discussed.     

A cyst arising from tunica vaginalis testis : report of a case

A 38-year-old man presented with left intrascrotal painless mass. Ultrasound and magnetic resonance imaging (MRI) examinations demonstrated a cystic lesion at the upper side of left testis without enhancement. This mass gradually enlarged in size, and left high orchiectomy was planned. Because intraoperative finding showed a cyst arising from tunica vaginalis testis, excision of the cyst was performed. Histopathological examination showed a cyst with a fibrous wall lined with cuboidal endothelial cells without malignancy. To our knowledge, this is the 15th reported case of a benign cystic lesion in tunica vaginalis testis in Japan. The age distribution of patients showed two peaks ; one from 5 to 8 years old and the other from 30 to 69 years old. Most of the pediatric patients showed acute scrotal swelling with pain. On the other hand, most adult patients demonstrated painless scrotal swelling with slow growth. Operative investigation should be performed in cases with suspicion of malignancy.     

睾丸表皮样囊肿7例报告并文献复习

目的探讨睾丸表皮样囊肿的临床特点及诊治方案。方法回顾性分析2003年1月至2013年6月我院收治的7例睾丸表皮样囊肿的临床资料,结合文献复习进行讨论,其中6例采用肿瘤剜除术,1例采用睾丸切除术。结果术后随访6个月~10年,无肿瘤复发及转移。结论睾丸表皮样囊肿是少见的睾丸良性肿瘤,B超、CT、MRI检查对诊断本病有重要作用,推荐保留睾丸的单纯肿物剜除术作为主要的治疗方式。     

Case of testicular venous hemangioma

A case of a testicular venous hemangioma is presented. A 65-year-old man complained of left testicular swelling. Physical examination and ultrasonography revealed a 2.0 x 1.6 x 1.5 cm roundish, well demarcated isoechoic elastic hard tumor in the left testis. No other abnormal findings including tumor markers were observed. Since preoperative examination did not rule out malignancy, we performed left high orchiectomy. Pathological diagnosis was a venous hemangioma of the left testis. Venous hemangioma is a rare entity among the testicular solid lesions.     

A case of retroperitoneal venous aneurysm]

A case of retroperitoneal venous aneurysm is reported. A 73-year-old woman was referred to us with the chief complaint of left abdominal mass. A giant abdominal mass was palpable and diagnostic imaging examination including ultrasound tomography, excretory pyelography, computed tomography, magnetic resonance imaging and angiography revealed a giant cystic mass encircled by calcification in the left retroperitoneal space. Operation for this cystic mass was performed under the preoperative diagnosis of a giant left renal cyst. During operation the mass was located between the left kidney and the left adrenal gland. Because it was difficult to separate the mass from the left kidney the mass was removed with the left kidney. The extirpated tumor measured 15.5 x 15.0 x 9.5 cm and contained old blood clots and red-yellow colored fluid. A histological examination revealed that the tumor wall was composed of smooth muscle and elastic fibers. Therefore, pathological diagnosis was retroperitoneal venous aneurysm. Retroperitoneal venous aneurysm is very rare. To our knowledge, this is the 8th case of retroperitoneal venous aneurysm reported in Japan.     

A case of chronic scrotal hematocele and review of the literature]

A 38-year-old man visited our hospital because of swelling of left scrotal content. He had no history of trauma of scrotum, fever, pain or dysuria. Physical examination revealed a tumor larger than a fist in the left scrotum. Ultrasonography revealed an echogenic mass with echolucent area in the scrotum. Surgical extirpation of the left scrotal tumor was performed under the diagnosis of left testicular tumor. The mass was encapsulated by a white fibrous membrane and was 700 g in weight. The tumor contained 200 ml of dark brown pus-like material. Histological examination revealed deposition of cholesterine crista and infiltration of lymphocyte in tunica vaginalis with extremely atrophic testis, destructive spermatogenesis and atrophic epididymis. Twenty one cases of chronic scrotal hematocele have been reported in the Japanese literature. The age of the patients reported was 38 to 77 years old with a mean age of 65 years. Orchiectomy was done under the diagnosis of testicular tumor in 20 of the 21 cases. Our case was thought to be of an idiopathic chronic scrotal hematocele. The disease should be considered even in the absence of a particular cause such as injury and inflammation of scrotal content.     

Solitary genital leiomyoma of the tunica dartos: a case report and review of the literature in Japan

We report a case of solitary genital leiomyoma arising from the tunica dartos of the scrotum. A 43-year-old man complained of a slightly tender left scrotal mass that had enlarged over approximately 17 years. On physical examination, the tumor was pedunculate and attached to the lower pole of the left scrotum. The tumor was clearly separate from scrotal contents such as the testis, epididymis, and spermatic cord. Ultrasonography showed the tumor to be 20.0 X 23.5 mm in diameter. Other laboratory examination findings were normal. Under local anesthesia, the tumor was resected at its base with overlying skin. On histopathological examination, the tumor consisted of interlacing bundles of smooth muscle cells, which were positive for vimentin, desmin, and a-actin. The tumor was diagnosed as leiomyoma arising from the scrotal tunica dartos. As solitary genital leiomyoma of the tunica dartos is rare, we have presented this case history and reviewed 23 cases that occurred in Japan.     

Epidermoid cyst originating from an intrapancreatic accessory spleen

We report a rare case of an epidermoid cyst originating from an intrapancreatic accessory spleen, in a 40-year-old Japanese man with no clinical symptoms. A cystic tumor in the pancreatic tail was detected incidentally by abdominal ultrasonography. The patient was referred to the KKR Tachikawa Hospital for further examination of the tumor. Preoperative imaging findings suggested that the tumor was an epidermoid cyst originating from an intrapancreatic accessory spleen. On both pre-and post-contrast computed tomography and magnetic resonance images, the solid compartment of the tumor had the same X-ray attenuation and intensity as the spleen. Upon surgical excision, the mass consisted of solid and cystic components that were macroscopically evident on the preoperative images. Microscopic analysis revealed that the solid component was an accessory spleen in the pancreatic tail, whereas the cystic component was lined with stratified epithelium representative of an epidermoid cyst. This is the thirteenth report (in English) of an epidermoid cyst originating from an intrapancreatic accessory spleen, and the first case to be diagnosed prior to surgery.