Epidermoid cyst of the testis in an adolescent: Case report and review of the evolution of the surgical management

Epidermoid cyst, a tumorlike lesion, is a rare benign testicular tumor with typical, distinctive ultrasonographic appearance. When the preoperative features are highly suggestive of epidermoid cyst, testicular sparing surgery after strict oncologic guidelines is warranted. The authors report a case of a preoperatively suspected epidermoid cyst in an adolescent and review the literature concerning the changing paradigm of management.     

Epidermoid cysts of the testes in Taiwanese men

Epidermoid cyst is a rare benign tumor of the testes. The records from the last 20 years of Taiwanese patients in whom a testicular tumor was diagnosed were reviewed retrospectively. Patients with a confirmed epidermoid cyst of testis were evaluated for age, clinical assessment and follow-up. Among a total 146 testicular tumors, 28 (19%) patients had a benign tumor including 15 patients (10%; mean age 23 years, range 17-32 years) with an epidermoid cyst diagnosed pathologically. Pre-operative suspicion of the benign nature of the lesions was supported by testicular ultrasonography in 11 patients. Seven patients underwent magnetic resonance imaging after which benign epidermoid cyst was impressed in five patients. A testicular-sparing operation was performed in 12 patients after frozen sections confirmed the diagnosis. Three patients were treated by radical orchiectomy. There was no relapse after a median follow-up of 42 months (range, 2-82 months). Ultrasonography and magnetic resonance imaging of the scrotum may allow the diagnosis of epidermoid cyst of the testes to be made pre-operatively. The absence of relapse in these patients further supports the use of organ sparing surgery in these young men.     

Microsurgery for intradural epidermoid cyst at cauda equina level in a 9-year-old child: A case report

Introduction and importanceEpidermoid cysts are rare benign tumors. Here, we present a case of spontaneous intradural epidermoid cyst at cauda equina level in a 9-year-old patient, which we believed the first case to be reported in Vietnam.Case presentationA 9-year-old boy presented with 4 months of spontaneous left lower extremity muscle weakness and paresthesia. The MRI images suggested the diagnosis of intradural epidermoid cyst at cauda equina level. The patient underwent L5–S1 laminectomy and durotomy for tumor resection. The histology confirmed the diagnosis of epidermoid cyst. Post-operative images demonstrated total cyst removal.Clinical discussionThe epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed.ConclusionDiagnosis of spinal epidermoid cyst is often delayed for its obscure presentation. Microsurgical dissection along with intra-operative mobile C-Arms enable total tumor resection while preserving spinal stability and neurological function. Follow-up with post-operative magnetic resonance imaging and tumor marker are helpful.     

Epidermoid cysts of the cerebellopontine angle with extension into the middle and anterior cranial fossae: surgical strategy and review of the literature

Summary Epidermoid cysts are tumours, which contain keratin, cellular debris and cholesterol, and lined with stratified squamous epithelium. Clinically, epidermoid cysts behave like benign, slow-growing lesions. We present a 63 year-old man with a 6-month history of right periorbital pain and hypaesthesia in the area of the first and second branch of the trigeminal nerve. MRI revealed an epidermoid cyst of the cerebellopontine angle extending into the middle and anterior cranial fossae. Radical surgical removal of epidermoid cysts should be attempted, but a less aggressive surgical strategy should be considered if there is strong adherence to the surrounding brain tissue, particularly in eloquent areas. In this case, complete tumour removal was achieved via a suboccipital retrosigmoid approach.     

Giant extradural epidermoid cyst of the posterior fossa

We report an unusual case of giant extradural epidermoid cyst of the posterior fossa in a 73-year-old man. The patient presented headache and gait disturbance for 3-4 months, cerebellar ataxia, left cerebellar dysmetria, and perturbed balance. The CT-scan showed a huge posterior fossa extradural lesion with a small area of peripheral contrast enhancement. Outcome was good after total resection of the lesion via a suboccipital approach. Pathology reported an epidermoid cyst. Extradural epidermoid cyst is a rare benign tumor of the skull which sometimes can reach considerable size. It is a slow growing lesion and may cause mild neurological deficits. The goal of surgical treatment is total resection of the tumor with its capsule. The long-term prognosis is excellent after successful resection.     

肾表皮样囊肿1例报告并文献复习

目的探讨肾表皮样囊肿的临床特点、诊断和治疗方法。方法回顾分析1例肾表皮样囊肿伴肾结石患者的临床资料。结果患者行根治性右肾切除,病理报告为右肾表皮样囊肿。患者术后1周痊愈出院,随访10个月未见肿物复发转移。结论肾表皮样囊肿为罕见的肾脏良性肿瘤,临床上报道极少。临床症状缺乏特异性,诊断较困难,需与肾脏肿瘤、囊性肾癌等相鉴别。     

Giant earlobe epidermoid cyst

Epidermoid cysts represent the most common cutaneous cysts. They are usually small and benign; however, sometimes they can grow to giant epidermoid cists, and occasionally malignancies develop. Giant epidermoid cysts at the earlobe have never been described but in other locations. We describe a case of a giant epidermoid cyst at the earlobe, a location where such a large cyst has never been reported before. The mass was completely resected and the wound of the pedunculated base was sutured with four stitches of nylon 5/0. Histopathology confirmed the presumptive diagnosis of an epidermoid cyst. Six months after the resection, the patient did not have any relapse of the epidermoid cyst. The earlobe is a potential location for giant epidermoid cysts. Although the clinical diagnosis could be enough, due to the possibility of malignancy and to ensure appropriate diagnosis, we consider that all cysts should be sent to the anatomic pathology laboratory for histological evaluation.     

Benign testicular tumors

Testicular tumor is considered rare in Oriental people and benign testicular tumor has never been reported from this area. From 1969 to 1985 70 cases of intratesticular tumors were treated at Tri-Service General Hospital. 12 of them were benign in nature including 8 epidermoid cysts, 1 cavernous hemangioma, 1 foreign body granuloma with pseudocyst, 1 Sertoli cell tumor and 1 intratesticular simple cyst. A testis-sparing procedure was performed for 5 epidermoid cysts, the Sertoli cell tumor and the simple intratesticular cyst. The tumors were excised completely and the testes were preserved after careful and thorough frozen section pathological studies. One of the epidermoid cysts and the case of simple testicular cyst were diagnosed correctly before surgery by using scrotal ultrasound.     

Testis sparing surgery for epidermoid cyst of the testis: A case report

A rare tumour of a prepubertal child, an epidermoid cyst, was excised with testicular preservation. Childhood testicular tumours are usually benign. Although epidermoid cysts of the testis may have teratomatous component, testicular teratomas are generally benign in the prepubertal child. For these reasons testis sparing surgery seems applicable in childhood epidermoid cysts.     

Epidermoid cyst of the brain stem. Case report

Brain stem epidermoid cysts are extremely rare lesions. Only nine cases have been reported. Management of the epidermoid cyst is decompression of cyst contents and removal of cyst capsule. But in some cases resection of the cyst may result in a poor outcome because of cyst wall adhesion into the brain stem.     

A diaphragmatic retroperitoneal cyst

Diaphragmatic lesions are usually congenital bronchogenic cysts. A patient with a known diaphragmatic cyst presented with new onset right upper quadrant pain. Repeat imaging showed enlargement of the cyst, the CA19–9 cancer marker was raised at 312iu/ml (normal: <27iu/ml) and positron emission tomography combined with computed tomography showed focally increased uptake in the cystic wall. In view of symptoms and risk of neoplasia, the lesion was excised. Histology showed a benign epidermoid cyst. Features falsely suggesting neoplasia have been reported previously with benign splenic cysts but not with a benign diaphragmatic epidermoid cyst.     

Giant epidermoid splenic cyst

Giant epidermoid splenic cysts are rare benign tumors. Their treatment is becoming increasingly less aggressive and more conservative. We report the case of a young woman with a giant epidermoid cyst, which required open total splenectomy, and review the literature on benign congenital tumors of the spleen.     

Recurrent meningitis associated with complete Currarino triad in an adult--case report

A 58-year-old woman presented with Currarino triad manifesting as recurrent meningitis. Currarino triad is a combination of a presacral mass, a congenital sacral bony abnormality, and an anorectal malformation, which is caused by dorsal-ventral patterning defects during embryonic development. She had a history of treatment for anal stenosis in her childhood. Radiographic examinations demonstrated the characteristic findings of Currarino triad and a complicated mass lesion. The diagnosis was recurrent meningitis related to the anterior sacral meningocele. Neck ligation of the meningocele was performed via a posterior transsacral approach after treatment with antibiotics. At surgery, an epidermoid cyst was observed inside the meningocele. The cyst content was aspirated. She suffered no further episodes of meningitis. The meningitis was probably part of the clinical course of Currarino triad. Radiography of the sacrum and magnetic resonance imaging are recommended for patients with meningitis of unknown origin. The early diagnosis and treatment of this condition are important.     

Testis sparing surgery for epidermoid cyst of the testis: A case report

A rare tumour of the prepubertal child, an epidermoid cyst was excised with testicular preservation. Childhood testis tumours are usually benign. Although epidermoid cystes of the testis may have teratomatous component, testicular teratomas are generally benign in the prepubertal child. For these reasons testis sparing surgery seems applicable in childhood epidermoid cysts.     

Epidermoid cyst of the corpus callosum]

Epidermoid cysts are most commonly located in the cerebellopontine angle and the parasellar regions. The authors report a case of an epidermoid cyst of unusual location: it arises in the midline and involves the body of the corpus callosum with interhemispheric exophytic growth. Reviewing the literature they did not find any similar report. C.T. scan and M.R.I. are the methods of choice for establishing the diagnosis and differentiating between epidermoid cyst, dermoid cyst, lipoma and arachnoid cyst. M.R.I. is highly sensitive and is especially useful in determining tumour extension, particularly in the sagittal and coronal planes, essential for surgical treatment planning. Treatment should be complete surgical resection in order to avoid recurrence and chemical meningitis.     

Laparoscopic splenic total cystectomy in a patient with elevated CA 19-9.

True nonparasitic splenic cysts are rare. Reports of approximately 30 cases of benign true splenic cysts producing elevated CA 19-9 serum levels have been published. The traditional treatment of splenic epidermoid cysts is splenectomy. However, with all the advances in laparoscopic surgery, conservative laparoscopic approaches are accepted as the most preferred techniques for this benign disease. Laparoscopic cystectomy with its minimal invasiveness and low morbidity is the ideal technique for properly selected patients. So far, only one case report of laparoscopic cystectomy for splenic epidermoid cyst with elevated CA 19-9 levels has been published. This is the second known report of this procedure being performed to remove a splenic epidermoid cyst in a patient with elevated CA 19-9 levels.     

Pathogenesis of intraparenchymal epidermoid cyst in the brain: a case report and review of the literature

BACKGROUND: Intracranial epidermoid cysts are relatively common; however, epidermoid cysts in the brain parenchyma are rare. In addition, the etiology of intraparenchymal epidermoid cysts is not clear. CASE DESCRIPTION: A 61-year-old woman presented with convulsive seizures. CT and MRI revealed a mass lesion in the right parietal lobe. With low-grade glioma as a preoperative diagnosis, the tumor was totally excised, but the subsequent pathologic diagnosis was epidermoid cyst. CONCLUSION: Exact preoperative diagnosis of this disease would be helpful in preventing chemical meningitis. The etiology is likely related to the time and locus of sequestration of ectodermal tissue during fetal development. Clarifying the pathogenesis will lead to effective preventive measures.     

Intramedullary epidermoid cysts of the spinal cord. Case report.

Epidermoid cysts are tumors familiar to neurosurgeons, but intramedullary epidermoid cysts are rare. The authors report the case of a 6-year-old girl presenting with progressive paraparesis. A midthoracic intramedullary mass was revealed on myelography and magnetic resonance (MR) imaging and confirmed as an intramedullary epidermoid cyst at surgery, at which time the cyst was removed. This is the fourth report documenting a purely intramedullary epidermoid cyst occurring in a child. The pathology and etiology, epidemiology, clinical features, radiology (including MR image characteristics), and surgical treatment of such rare intramedullary benign tumors are discussed. Magnetic resonance imaging reduces the delay in diagnosis of spinal cord tumors but should be guided by clinical judgment.