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.     

Seminoma after orchiopexy. A case report

A 29-year-old man had been operated on for bilateral cryptorchism at the age of 11. The right testis was not found and was considered to be aplastic. The left testis was placed surgically in the scrotum. When he entered a follow-up study for early detection of testicular cancer, the right testis was found intraperitoneally and was removed. A left testicular biopsy showed carcinoma in situ and orchiectomy was performed. This testis contained an invasive seminoma.     

Cavernous hemangioma of the testis: a case report and review of the literature

A 73-year-old man consulted our hospital with a painless intra-scrotal mass in the left testis. Serum levels of human beta-chorionic gonadotropin and alpha-fetoprotein were normal. Scrotal ultrasonography demonstrated left testis with a heterogeneous texture. A diagnosis of probable testicular malignancy was made, and a left radical orchiectomy was performed. The histopathological diagnosis was testicular cavernous hemangioma. To our knowledge, only 19 cases of cavernous hemangioma of the testis have been reported in the literature so far. Although this is a rare tumor, it should be considered in the differential diagnosis of testicular tumor.     

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.     

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.     

Testicular cancer with inguinal lymph node metastasis in a patient with prior orchiopexy for undescended testis: a case report

A 36-year-old man referred to our hospital with the chief complaint of painful left inguinal mass and fever. He had undergone left orchiopexy for undescended testis at 10 years of age. With the suspicion of an incarceration of inguinal hernia, an operation was performed. However, there was no hernia sac, and only swelling inguinal lymph nodes were found. Pathological diagnosis of the nodes was metastatic embryonal carcinoma, with suspicion of testicular origin. As scrotal ultrasonography revealed a hypoehcoic mass within the left atrophic testis, left high orchiectomy was performed. Pathological diagnosis of the left testicular mass was seminoma. A definite diagnosis was left testicular cancer, mixed type of seminoma and embryonal carcinoma, with inguinal nodes metastasis, pT1N2M0. He received 3 courses of bleomycin, etoposide, and cisplatin (BEP) chemotherapy, and there has been no sign of metastasis nor recurrence 18 months after the operation. To our knowledge, this is the 11th case in Japan of testicular cancer with inguinal node metastasis in a patient with prior orchiopexy for undescended testis.     

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.     

Xanthogranulomatous orchitis with scrotal fistulas

Xanthogranulomatous orchitis is an extremely rare inflammatory change of testis which is difficult to distinguish from testicular tumor. We report on a 21-year-old man who presented with left testicular swelling and pyogenic discharge from the scrotum. Testicular tumor markers were normal. Scrotal ultrasonography showed a testicular tumor in the left testis. Because of severe adhesion between the scrotum and intrascrotal structures, radical orchiectomy combined with hemiscrotectomy was performed to exclude possible malignancy. Histopathological findings showed xanthogranulomatous orchitis.     

Relapse of brucellosis simulating testis tumor

We report on a case of a 32-year-old man referred for evaluation of a painless left testicular mass suggesting a testicular tumor. Previous history was uneventful except for a 3-year history of systemic brucellosis without epididymo-orchitis. Radical inguinal orchidectomy was performed. Clinical and histopathological findings indicated a brucellar abscess of the left testis. Even in the absence of systemic symptoms, the possible relapse of brucellosis as an abscess formation in the testis should be considered as a rare cause of testicular mass in patients who live in endemic regions.     

Metachronous bilateral testicular tumors in a case of male infertility

A 42-year-old man referred to our hospital with the chief complaint of a solid mass of right scrotal contents. As ultrasonography revealed a right testicular tumor, right high orchiectomy was performed and the pathlogical diagnosis was testicular seminoma. At the age of 35-year-old, he was admitted to another hospital for male infertility due to azoospermia. Because left testicular tumor was found, left high orchiectomy was performed, with right testicular biopsy and testicular sperm extraction of the right testis at the same time. Pathological diagnosis revealed left testicular seminoma and no malignancy of the right testicular biopsy specimen. After the second operation, he has been receiving androgen replacement therapy, with no evidence of tumor recurrence.     

Crossed testicular ectopia

Crossed testicular ectopia/transverse testicular ectopia is an extremely rare anomaly, in which both gonads migrate toward the same hemiscrotum. About 100 cases of transverse testicular ectopia have been reported in published studies. We report a case of transverse testicular ectopia in an 8-year-old boy who presented with right inguinal hernia and nonpalpable left testis. On exploration, both testes were present in the right inguinal region. Bilateral orchiopexy was performed by crossing the left testis in the preperitoneal space. The diagnosis could not be made preoperatively in most of reported cases. Magnetic resonance imaging, magnetic resonance venography, and laparoscopy are useful for diagnosis and management.     

Torsion of the spermatic cord in undescended testis: report of two cases

We report two cases of torsion of the spermatic cord in undescended testis. Case 1: A 23-year-old man was admitted to our hospital with the complaints of fever and left inguinal pain. He had cerebral palsy in his past history. Tentative diagnosis of acute epididymitis of left undescended testis was made, and antibacterial drugs were given. Response was poor, and torsion of the spermatic cord was suspected strongly. Torsion of the spermatic cord in undescended testis and severe testicular infarction were seen in surgery after 13-day conservative treatment. Orchiectomy was performed. Case 2: A 6-year-old boy was admitted to our hospital with the chief complaints of left inguinal mass and pain. He had felt abdominal pain for 3 days. Scrotal contents were impalpable and the diagnosis of torsion of the spermatic cord was made. Orchiectomy was performed due to severe testicular infarction.     

Bilateral testicular tumors recurring 31 years after the initial treatment: a case report and the literature review

We herein report a case of bilateral testicular germ cell tumor recurring 31 years after right high inguinal orchiectomy. In 2003, a 62-year-old man presented with a mass in the left testis. Ultrasonography demonstrated three hypoechoic mass and microlithiasis of the left testis. Abdominal and breast computed tomography revealed no lymph adenopathy and any metastasis. The preoperative diagnosis was stage I testicular tumor and subsequently left high orchiectomy was performed. Histological examination revealed typical seminoma. At present, the patient is free from recurrence after the surgery. To our knowledge, 166 cases were reported in Japan. Approximately fifty percent of metachronal bilateral testicular tumors previously reported have been recurred after five years and more from the initial surgery. In the testicular cancer, long-term follow-up and self examination of the scrotum are of great importance. We review the metachronal bilateral testicular germ cell tumors previously reported in Japan.     

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.     

Splenogonadal fusion: Report of a case

A 15-year-old male patient was admitted to our hospital with a left undescended testis. He also suffered from congenital limb defects. Ultrasonography revealed atrophic testicular tissue in the left groin, approximately 2-cm in size. Upon left inguinal exploration, atrophic testicular tissue was found and an orchidectomy was performed. Histopathological examination revealed splenogonadal fusion, which has a known association with congenital limb defects.     

A rare simultaneous presentation of testicular mixed germ cell tumor with a contralateral testis torsion

We report a rare case of a 27-year-old man presenting with an acute scrotum with simultaneous occurrence of testicular tumor and contralateral torsion. Preoperative imaging demonstrated the testicular missed torsion, yet findings were equivocal with regard to the testicular tumor. On scrotal exploration the left testis was found to be ischemic due to threefold rotation. The right testis was not identifiable, being composed of numerous necrotic lesions. Frozen section suggested malignancy, hence high right orchiectomy was performed. Histologic examination of the right testis showed mixed germ cell tumor, containing all the subtypes. To our knowledge no similar case has been reported.     

A case of Sertoli cell tumor

We report a case of Sertoli cell tumor. A 33-year-old man visited our clinic with a complaint of painless left scrotal swelling on September 29th, 2003. An elastic firm induration larger than a hen's egg in size was palpable on the surface of the left testis. Tumor markers for testicular tumor such as human chorionic gonadotropin-beta, alpha fetoprotein, and lactate dehydrogenase were not elevated. However, ultrasound showed a low echoic mass in the left testis. Therefore, we performed left high orchiectomy under the diagnosis of left testicular tumor. Its histology showed Sertoli cell tumor. Neither recurrence nor metastasis has been detected for about 8 months after the operation.     

Testicular germ cell tumor arising in the male with a chromosomal abnormality of 45,X/46,X,del(Y)

A 25-year-old-man came to our outpatient clinic complaining of swelling of the left scrotal contents. He had a past history of 3 surgeries for hypospadia. His left testis was stony hard and testicular tumor was suspected. High orchiectomy was performed under general anesthesia. The pathological diagnosis was mixed type testicular germ cell tumor. Chromosomal analysis revealed a karyotype of 45,X/46,X,del(Y). Most of the long arm of the Y chromosome was missing. Prophylactic chemotherapy was performed. Treatment options for genetically high risk patients of testicular malignancies were discussed.     

A case of primary testicular malignant lymphoma associated with contralateral testicural recurrence after a seven-year interval

A 70-year-old male presented to our hospital in October 1999 complaining of right scrotal swelling. Right high ligation of testis was performed. Pathological examination demonstrated a diffuse large B-cell lymphoma (DLBCL) originating from the right testis. He underwent four courses of adjuvant chemotherapy consisting of CHOP (cyclophosphamide, doxorubicin, vincristin, prednisone) together with 40 Gy radiotherapy to the contralateral testis. Following this treatment he achieved complete remission. Seven years later in March 2006, he developed swelling of the left scrotum. He underwent left high orchidectomy based on the suspicion of a contralateral testicular malignant lymphoma. Pathological examination of the testicular specimen confirmed a diagnosis of DLBCL. He underwent chemotherapy and has survived without evidence of recurrence. We have summarized the cases of bilateral asynchrony primary testicular lymphoma.     

The effects of unilateral, experimental varicocele are not mediated through the ipsilateral testis

Unilateral varicocele has been associated with diminished male fertility in humans and with bilateral physiologic and histologic changes in the testis of humans and laboratory animals. In particular, left varicocele in Sprague-Dawley rats results in bilateral increases in testicular temperature and blood flow. The mechanism by which unilateral varicocele can cause testicular changes is not known. The purpose of the present study was to determine whether or not the presence of either the ipsilateral or contralateral testicle is necessary for these effects of the varicocele to occur in the opposite testis. Varicoceles were created in adult, male rats by partial constriction of the left renal vein. Bilateral testicular blood flow was measured by a radiolabelled microsphere distribution technique and testicular temperature was taken with a needle probe thermometer. Right or left orchiectomies were performed on selected animals at the time of surgery to establish the unilateral left varicocele. Animals were studied 30 days after surgery. Mean testicular blood flow was significantly increased (P less than 0.01) in all animals having a left varicocele when compared with animals not having a varicocele regardless of whether a unilateral orchiectomy was performed. Likewise, the mean difference between intraabdominal temperature and intratesticular temperature (delta T) was significantly decreased in all groups of animals having varicoceles when compared with groups without varicoceles whether or not an orchiectomy had been performed. Thus, the studied bilateral effects of left-sided, experimental varicocele in the rat are not dependent upon the presence of a left testicle.