Epididymal cysts in children: natural history

PURPOSE: We reviewed the outcome of conservative management of epididymal cyst in children at our institution. MATERIALS AND METHODS: We retrospectively reviewed the records of all patients with epididymal cyst from 1991 to 2002. Age and mode of presentation as well as time to complete involution of the cysts were studied. Diagnosis of epididymal cyst was confirmed by scrotal ultrasound in all cases. RESULTS: A total of 20 patients were identified with epididymal cyst. Average patient age at presentation was 10.5 years. Fifteen patients presented with scrotal mass and 4 with scrotal pain. Cysts were between 3 and 30 mm. Only 1 patient required surgical excision due to persistent pain. Epididymal cysts resolved in 10 patients who completed followup. Average time to complete regression was 17 months. None of our patients had a history of exposure to diethylstilbestrol, cryptorchidism, cystic fibrosis or von Hippel-Lindau disease. CONCLUSIONS: Our findings imply that most epididymal cysts involute with time.     

Epididymal germinoma: Reality or myth?

Epididymal tumours are rare, but definite pathological entity. Most tumours are benign, however, malignant lesions have also been reported. The common benign tumours are either leiomyomas or adenomatoid tumours. Malignant pathologies include primary epididymal adenocarcinoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, mesothelioma and lymphoma. We present a case of a 45-year-old male referred urgently for suspected scrotal mass which on ultrasonography showed a lesion in the left epididymal head (possible granuloma).     

Hemorrhagic cyst of the cavum tunica vaginalis testis: a case report

The patient, an eight-year-old boy, visited our clinic with the chief complaint of right painful scrotal swelling persisting for two days. A scrotal puncture yielded 9 ml of bloody fluid. Afterwards a small cystic mass was detected near the epididymal head on palpation and by ultrasonography. Laboratory test results including bleeding tendency were normal. A pedunculated red cystic mass originating from the parietal lamina of the tunica vaginalis testis was found on emergency operation. Histological examinations revealed hemorrhagic cyst of the tunica vaginalis testis with no malignancy.     

Epididymal leiomyoma: a benign intrascrotal tumour

Physicians will be rarely confronted with epididymal tumours. These represent only 5% of intrascrotal tumours and are mostly (75%) benign. We report the case of a 50‐year‐old white male who was presented with a 5‐year history of a slow‐growing, left scrotal mass, noted through self‐examination. Ultrasound study of the scrotum identified a well‐circumscribed paratesticular mass. On inguinal surgical exploration, a solid, encapsulated, grey‐white mass at the tail of the left epididymis was identified and excised, with intra‐operative pathological consultation showing no signs of malignancy. The diagnosis of an epididymal leiomyoma was determined through subsequent immune‐histopathological analysis. Diagnostic steps preceding operative exploration of a paratesticular, epididymal tumour are briefly analysed and physicians are encouraged to avoid a radical approach, without prior pathological consultation. Epididymal leiomyomas are benign tumours that can be cured through simple, organ‐preserving surgical excision.     

原发性附睾肿瘤

目的提高对原发性附睾肿瘤的诊治水平。方法报告原发性附睾肿瘤２３例,良性２２例（９５．７％）,其中附睾腺样瘤１４例,平滑肌瘤６例,附睾多发纤维假瘤１例,硬化性血管瘤１例。恶性１例,为附睾腺癌。良性肿瘤作单纯肿瘤或患侧附睾切除。结果预后良好,１９例获随访,术后无复发。恶性肿瘤预后差,处理方法与睾丸恶性肿瘤相同。附睾肿瘤极易误诊为附睾结核、慢性附睾炎、精液囊肿等。结论良性肿瘤除具有一定良性表现特征外,采用Ｂ超及针吸细胞学检查,有助于术前对该病的诊断。恶性肿瘤生长迅速,往往侵及睾丸精索。     

Management of epididymal cysts in childhood

Background

A retrospective review was carried out to evaluate the clinical presentation of children with epididymal cysts (EC) and outcome of management at our institution.

Methods

There were 49 patients with EC in this series. The diagnosis of EC was made by physical examination and confirmed by ultrasound (US).

Results

The average age at presentation was 10.7 years (2 months–16 years). Scrotal mass (n: 22) and pain (n: 21) were the most frequent symptoms. Seven patients were lost to follow-up. The cysts were solitary in 32 patients and multiple in 10 patients. The mean value of cysts was 6.7 mm (2–20 mm). The cyst localisations were 22 in left, 16 in right, and bilateral in 4 patients. Complete involution of cysts was detected in 14 children. The average involution time was 11.2 months (1–37 months). In 20 cases, a decrease in cyst size was found. Cyst excision was performed in 8 patients with persistent scrotal pain or no cyst involution observed during follow-up.

Conclusion

Conservative management of epididymal cysts is practical. However, surgical excision is recommended in patients with intractable scrotal pain or if the cyst size does not seem to involute.     

Benigne zystische Raumforderungen des Hodens

Testicular cysts are increasingly diagnosed in the course of scrotal ultrasound examination. Among other things this is due to the general availability of modern high-resolution ultrasound devices. Benign and malignant diseases with testicular cyst formation need to be differentiated by differential diagnosis and by their aetiology. Benign diseases with cystic space-occupying lesions of the testicle are tubular ectasia of the rete testis, cystic dysplasia, epidermoid cysts, simple intraparenchymatous testicular cysts and cysts of the tunica albuginea. Testicular dermoid cyst was long misleadingly regarded as potentially malignant, but is now classified as benign. On diagnosis of a benign lesion of the testis an organ-conserving surgical therapy or an observational watch-and-wait strategy can be recommended in most cases.     

Torsion of an epididymal cyst

Torsion of an epididymal cyst is a very rare condition. We present a case of torsion of an epididymal cyst in a 13-year-old boy. The patient presented with acute scrotal pain. Scrotal ultrasonography showed a 38 x 35 x 30 mm fluid-filled mass within the caput of the left epididymis. Histologically, the cells of the epididymal duct were necrotic. To our knowledge, this is the second case report in the literature.     

Prenatal diagnosis of a large, cervical, intraspinal, neurenteric cyst and postnatal outcome

Neurenteric cysts are rare congenital anomalies derived from the notochord and located in front of the spinal column, mostly at the cervical level. They consist of an intraspinal cystic component that is connected to a mediastinal or thoracic cyst. A case of a cervical, intraspinal, neurenteric cyst, diagnosed at 28 weeks of gestation and operated on at 3 and half months after birth, is reported. Herein, we discuss important features of this case including its rare occurrence, intrauterine diagnosis, and early surgical intervention. In conclusion, the nature of prenatal intradural cysts should be fully evaluated and differentiated between neurenteric cyst and other types of cysts with fetal ultrasonography. Therefore, it is essential to be aware of this potential cyst in fetal ultrasonography in utero. Neurenteric cyst should be considered in the differential diagnosis of cervical intradural cystic lesions. In infants, successful surgery provides a cure in patients with cervical neurenteric cysts.     

Congenital true pancreatic cyst detected prenatally in neonate: a case report

True congenital epithelium-lined cysts of the pancreas are rare, and the prenatal diagnosis of a true pancreatic cyst has been reported only rarely. In this article, the authors report a 3-day-old girl with histologically proven true pancreatic cyst that was detected by prenatal ultrasonography. The cystic mass was located in the left upper side of the abdomen, and total cystectomy was performed without complication.     

Leiomyomas and extramucosal cysts of the esophagus in adults. The clinical picture and surgical therapy

BACKGROUND: Leiomyoma is the most common type of benign esophageal tumor, whereas extramucosal cysts of the esophagus are congenital anomalies frequently asymptomatic in the adult and in most cases detected incidentally on chest X-ray. Conventional imaging tests do not lead to a precise diagnosis. Endoscopic ultrasonography is very accurate in visualizing these lesions and in differentiating cystic from solid submucosal esophageal masses; in addition, the test can establish the exact location of the mass in relation to the esophageal wall and mediastinum. METHODS: Fifteen patients with esophageal leiomyoma and 27 patients with extramucosal esophageal cyst were operated on in our Institution. Dysphagia was the most common symptom in patients affected by leiomyoma and esophageal duplication cyst, whereas chest pain was more frequent in patients with bronchogenic cyst. RESULTS: Complete surgical excision of the mass was performed in all patients with esophageal leiomyoma and in 26 patients with mediastinal cyst, while a right upper pulmonary lobectomy was performed in the patient with an intrapulmonary cyst. CONCLUSIONS: Endoscopic ultrasonography plays an important role in the differential diagnosis of leiomyoma and mediastinal cyst. Surgery is mandatory in all patients especially after the advent of the mini-invasive procedures. Observation alone must be reserved for patients who refuse or are not suitable for thoracic surgery.     

A case of bilateral intrathyroidal branchial cleft cyst in a newborn

We describe an extremely rare case of bilateral intrathyroidal branchial cleft cysts. A 2-day-old male neonate presented with intermittent tachypnea, dyspnea, and a palpable neck mass. Cervical ultrasonography and computerized tomography scan demonstrated a right-sided 3 × 3-cm cystic mass and a left sided 4.5 × 4-cm cystic mass, thought to be originating in the thyroid gland. The right-sided cyst decreased in size after OK-432 sclerotherapy. The left-sided cyst showed little response to 2 attempts of OK-432 sclerotherapy. Surgical removal of the left-sided cyst was done because of intermittent airway problems. The cystic mass was thought to be an intrathyroidal lesion. Microscopically, the cyst was lined by nonkeratinized squamous epithelium and respiratory epithelium. Lymphocyte infiltration was found in the subepithelial layer. The patient is currently doing well 12 months later with no evidence of recurrence.     

Color Doppler ultrasonography as a routine clinical examination in male infertility

AIM: We assessed the value of scrotal color Doppler ultrasonography as a routine examination in infertile men. METHODS: Color Doppler ultrasonography was performed in 545 infertile men with a mean age of 35.8 years to detect intrascrotal abnormalities. Findings were compared with those of physical examination. RESULTS: Intrascrotal abnormalities were detected by ultrasonography in 65.3% of patients. Of 374 abnormalities, 58.3% were undetected by physical examination. Left varicocele was found in 313 patients (57.4%); testicular microlithiasis in 30 (5.5%); epididymal cyst in 21 (3.9%); right varicocele in 4 (0.8%); and testicular cysts in 3 (0.6%). One occurrence each (0.2%) was found for testicular tumor, intrascrotal hemangioma, and hydrocele of the spermatic cord. Compared to ultrasonography, sensitivity in detecting left varicocele by physical examination was 58.4%; specificity, 79.3%; accuracy, 67.3%; and positive predictive value, 79.3%. Venous diameters in the pampiniform plexus were 3 mm or more in 61.5% of 130 subclinical left varicoceles. Of 30 patients with testicular microlithiasis, 14 had varicocele, 2 had epididymal cyst,s 3 had a history of mumps orchitis, 1 had retractile testis, and 1 had a history of orchiectomy for contralateral testicular tumor. CONCLUSIONS: The routine Color Doppler ultrasonography is valuable for diagnosing scrotal abnormalities in infertile men, frequently detecting non-palpable lesions.     

Bilateral multilocular cystic renal cell carcinoma]

A case of bilateral renal cell carcinoma with multilocular cysts is described. A 42-year-old female was admitted to our hospital for the purpose of further examination or right renal cystic mass discovered incidentally by ultrasonography. After she was examined by CT-scan and angiography, right nephrectomy was performed under the diagnosis of right renal cancer. Histological diagnosis was multilocular cystic renal cell carcinoma. One year later a small cystic legion was found in the left kidney. Under the diagnosis of left renal cancer, left partial nephrectomy was performed. Histological diagnosis was multilocular cystic renal cell carcinoma same as the right kidney. Multilocular renal cyst is classified into several classes by its style of development. This case of bilateral renal cell carcinoma which grew to be multilocular cysts is the first case in Japan as far as we can search.     

附睾肿物的超声诊断与鉴别诊断

目的:通过分析附睾肿物的超声特征,提高对附睾肿物的超声诊断及鉴别诊断水平。方法:回顾性分析1990年1月~2004年12月在我院接受手术治疗的179例附睾肿物患者,对病理诊断和超声特征进行分析。结果:179例患者,年龄(51.4±14.7)岁。附睾肿物包括附睾囊性肿物98例,非特异性附睾炎症27例,附睾结核33例,附睾肿瘤21例。附睾疾病中囊性肿物超声诊断率93.8%;附睾结核与附睾炎不易鉴别,两者主要区别在于附睾结核常同时合并肾、输尿管、膀胱、前列腺和睾丸等多脏器结核,在出现寒性脓疡、钙化灶,与皮肤形成窦道时易诊断;附睾肿瘤多为良性,恶性少见,应结合病史、体格检查和超声特征综合鉴别。结论:超声检查对附睾肿物的诊断和鉴别具有重要临床价值,是附睾疾病的首选影像学检查方法。     

Retroperitoneal bronchogenic cyst: a case report and review of the literature

This unusual clinical case adds itself to the limited list of existing reports of retroperitoneal bronchogenic cysts in the international literature. It emphasizes the difficulties encountered in making a preoperative diagnosis, since these lesions can be described as both solid and cystic masses. A 69-year-old man underwent surgery to remove an expanding mass diagnosed as originating in the adrenal gland and discovered during clinical investigation for other indications. The lesion was excised only after adrenalectomy whereupon its cystic nature was revealed. Retroperitoneal bronchogenic cysts, though rare, should be considered in the differential diagnosis of retroperitoneal expanding lesions, especially in the presence of cystic tumours of the left adrenal region. This is the first case of a retroperitoneal bronchogenic cyst reported in an adult in Italy.     

不育男性患者前列腺和阴囊的超声检查

目的:评价不育男性患者行前列腺和阴囊Doppler超声检查的临床意义。方法:总结268例不育男性患者前列腺和阴囊的超声资料,并与临床体检进行对比。结果:268例中182前列腺和(或)阴囊异常(67.9%)。其中,前列腺结石14.9%,前列腺囊肿2.2%,附睾囊肿13.1%,睾丸囊肿0.4%,睾丸内微小结石3.4%,睾丸鞘膜积液3.0%,精索静脉曲张24.3%。与触诊比较,精索静脉曲张的的检出率超声是24.3%,触诊是14.5%,差异有统计学意义(P<0.05)。将患者按精液常规分成无精子症、少精子症和精子密度正常等3组,超声异常率依次为80.5%,75.4%和55.6%,各组间差异亦有统计学意义(P<0.05)。结论:超声是诊断不育男性前列腺和(或)阴囊异常的重要手段,与临床触诊相比,其结果更为客观、可信。     

Lymphoepithelial cysts of the pancreas: Case report and review of the literature

The aim of this report was to describe the clinical and pathologic features of lymphoepithelial cysts of the pancreas, establish the differential diagnosis of other pancreatic cysts, and review the literature.A 53-year-old man was incidentally diagnosed with a pancreatic lesion after an abdominal CT scan. This study showed a solid mass in the tail of the pancreas not enhanced by helical CT. Endoscopic ultrasound examination revealed a low-density tissue mass on the surface of the pancreas, less echogenic than the surrounding parenchyma. Distal pancreatectomy and splenectomy were performed with a suspected diagnosis of mucinous cystic tumor. The patient has had an uneventful postoperative period, and the pathologic finding was a lymphoepithelial cyst of the pancreas. Lymphoepithelial cyst of the pancreas is an unusual and benign entity that must be taken into consideration when evaluating a cystic lesion of the pancreas because a different therapeutic approach may be required.     

Successful laparoscopic removal of mesenteric and omental cysts in toddlers: 3 cases with a literature review

Mesenteric and omental cysts are rare benign intraabdominal anomalies with uncertain etiologies. Surgical removal is the preferred treatment owing to complications related to cyst enlargement. A 1-year-old boy with an intrauterine diagnosis of a cystic mass adjacent to his stomach and liver, a 3-year-old girl, and a 3-year-old boy with an incidental diagnosis of intraabdominal cysts were scheduled for laparoscopic surgery. The mass of the 1-year-old boy was a multiloculated cyst originating from the lesser omentum, the incidental mass in the girl was a multiseptated cyst located in the jejunoileal mesentery, and the incidental mass of the 3-year-old boy was a uniloculated cyst originating from the ileal mesentery. All the cysts were excised either laparoscopically or in a laparoscopy-assisted manner. The laparoscopic or laparoscopy-assisted excision of the mesenteric and omental cysts seems to be a feasible, safe, and cost-effective surgical procedure with shorter operative times, even in toddlers.