INTRATESTICULAR
EPIDERMOID
CYST
A Rare Benign Tumor DOUGLAS
S. DAHL,
M.D.
From the Division of Urology, Department of Surgery, University of Utah Medical Center and the Holy Cross Hospital, Salt Lake City, Utah
ABSTRACT - Epidermoid cysts rarely arise within the testis. The incidental discovery of a distinct, intratesticular epidermoid cyst in a nineteen-year-old man is reported. Management by radical orchiectomy is stressed because grossly the tumor is indistinguishable from a malignant testicular tumor.
Carcinoma ofthe testis is the fourth most common neoplasm of males between the ages of fifteen and thirty-four years and accounts for 11 to 13 per cent of all cancer deaths in this age group.’ Since nearly all intratesticular neoplasms are malignant, the discovery of a rare, benign testicular tumor in a nineteen-year-old man is noteworthy. Case Report A nineteen-year-old healthy man was admitted to the Holy Cross Hospital onDecember 7,1973, because of an acute knee injury sustained while skiing. The left knee was swollen and painful. The remainder of the physical examination was unremarkable except for an asymptomatic, painless mass occupying the upper pole of the right testis. Chest x-ray films were normal; x-ray studies ofthe knee showed only soft tissue swelling, and an intravenous urogram demonstrated normal kidneys, ureters, and bladder. Laboratory data were all within normal limits. Surgical exploration of the left knee on the day of admission revealed a tear of the medial collateral ligament and a torn meniscus. The ligament was reconstructed and the meniscus excised. Urologic examination confirmed the presence of a firm, spherical intratesticular mass. The left testis was normal. Radical orchiectomy was recommended because of the high probability of a primary, malignant carcinoma within the right testis.
696
Surgical exploration was performed on December 11, 1973. The right inguinal canal was exposed through a groin incision. The spermatic cord was occluded with an atraumatic vascular clamp, and the testis extruded from the scrotum. The solid mass, visible beneath the tunica albuginea, had the appearance of a malignant tumor; therefore, the spermatic cord was amputated and the testis removed within the intact spermatic fascia. The inguinal wound was closed in layers, without drains. The patient’s postoperative course was uneventful, and he was discharged from the hospital four days after the operation. Pathologic examination A spherical mass lay beneath the intact tunica albuginea. Transection of the testicle revealed a 1.5-cm. yellow-white nodule surrounded by a distinct fibrous capsule. The contents of the capsule “shelled-out” easily and consisted of scaly, caseous material (Fig. 1). Microscopic sections show a hyalinized, fibrous cyst wall, rimmed by flattened epithelium and containing keratinous debris. No evidence of malignancy was visible. Comment Epidermoid cysts of the testis constitute less than 1 per cent of testicular neoplasms. Price’s’ review of 5,845 testis tumors in the Testicular Tumor Registry of the Armed Forces Institute of
UROLOGY
/ MAY 1975 / VOLUME
V, NUMBER 5
made until the testis is sectioned, radical orchiectomy is the established treatment. Recurrence and metastases have not been reported. Although the present case proved to be an unusual, benign testis tumor, it must be stressed that all testicular masses must be considered malignant until a histologic diagnosis is obtained. Trans-scrotal exploration is to be condemned. Proper surgical management must include exposure of the spermatic cord in the inguinal canal, complete occlusion of all cord structures, and inspection and palpation of the lesion through an intact fascial envelope. This method of orchiectomy prevents contamination of the incision by tumor and permits manipulation without the fear of tumor embolization into the spermatic veins and lymphatic vessels, providing an excellent chance of controlling the primary tumor.4 ,
Transected testis showing normal compressed testicular tissue surmounted by I .5 cm. spherical nodule encased in fibrous capsule. Tunica albuginea is intact; at left side of open cyst is an empty hemisphere of j&rous capsule. Caseous sebaceous material which was extruded from the capsule lies at left side of capsule.
FIGURE 1.
Pathology showed only 69 cases; previously, only 30 cases had been reported.3 This lesion has distinctive pathologic characteristics including the well-defined cyst wall, a keratin-filled cyst cavity, and the absence of teratomatous elements in the specimen. Since the diagnosis cannot be
UROLOGY
/ MAY1975
I VOLUMEV.
NUMBER5
50 North Medical Drive Salt Lake City, Utah 84132 References MOSTOFI, F. K., and PRICE, E. B. : Tumors of the male genital system, Armed Forces Institute of Pathology, Washington, D.C., 1973. PRICE, E. B.: Epidermoid cysts of the testis: a clinical and pathological analysis of 69 cases from the testicular tumor registry, J. Urol. 102: 708 (1969). GILBAUGH,J. H., JR., KELALIS, P. P., and DOCKERTY, M. B.: Epidermoid cysts of the testis, ibid. 97: 876 (1967). WHITMORE, W. F., JR.: Tumors of the testis, in Campbell, M. F., and Harrison, J. H., Eds: Urology, 3rd ed., Philadelphia, W. B. Saunders Co., 1970.
697
EPIDERMOID
CYST
A Rare Benign Tumor DOUGLAS
S. DAHL,
M.D.
From the Division of Urology, Department of Surgery, University of Utah Medical Center and the Holy Cross Hospital, Salt Lake City, Utah
ABSTRACT - Epidermoid cysts rarely arise within the testis. The incidental discovery of a distinct, intratesticular epidermoid cyst in a nineteen-year-old man is reported. Management by radical orchiectomy is stressed because grossly the tumor is indistinguishable from a malignant testicular tumor.
Carcinoma ofthe testis is the fourth most common neoplasm of males between the ages of fifteen and thirty-four years and accounts for 11 to 13 per cent of all cancer deaths in this age group.’ Since nearly all intratesticular neoplasms are malignant, the discovery of a rare, benign testicular tumor in a nineteen-year-old man is noteworthy. Case Report A nineteen-year-old healthy man was admitted to the Holy Cross Hospital onDecember 7,1973, because of an acute knee injury sustained while skiing. The left knee was swollen and painful. The remainder of the physical examination was unremarkable except for an asymptomatic, painless mass occupying the upper pole of the right testis. Chest x-ray films were normal; x-ray studies ofthe knee showed only soft tissue swelling, and an intravenous urogram demonstrated normal kidneys, ureters, and bladder. Laboratory data were all within normal limits. Surgical exploration of the left knee on the day of admission revealed a tear of the medial collateral ligament and a torn meniscus. The ligament was reconstructed and the meniscus excised. Urologic examination confirmed the presence of a firm, spherical intratesticular mass. The left testis was normal. Radical orchiectomy was recommended because of the high probability of a primary, malignant carcinoma within the right testis.
696
Surgical exploration was performed on December 11, 1973. The right inguinal canal was exposed through a groin incision. The spermatic cord was occluded with an atraumatic vascular clamp, and the testis extruded from the scrotum. The solid mass, visible beneath the tunica albuginea, had the appearance of a malignant tumor; therefore, the spermatic cord was amputated and the testis removed within the intact spermatic fascia. The inguinal wound was closed in layers, without drains. The patient’s postoperative course was uneventful, and he was discharged from the hospital four days after the operation. Pathologic examination A spherical mass lay beneath the intact tunica albuginea. Transection of the testicle revealed a 1.5-cm. yellow-white nodule surrounded by a distinct fibrous capsule. The contents of the capsule “shelled-out” easily and consisted of scaly, caseous material (Fig. 1). Microscopic sections show a hyalinized, fibrous cyst wall, rimmed by flattened epithelium and containing keratinous debris. No evidence of malignancy was visible. Comment Epidermoid cysts of the testis constitute less than 1 per cent of testicular neoplasms. Price’s’ review of 5,845 testis tumors in the Testicular Tumor Registry of the Armed Forces Institute of
UROLOGY
/ MAY 1975 / VOLUME
V, NUMBER 5
made until the testis is sectioned, radical orchiectomy is the established treatment. Recurrence and metastases have not been reported. Although the present case proved to be an unusual, benign testis tumor, it must be stressed that all testicular masses must be considered malignant until a histologic diagnosis is obtained. Trans-scrotal exploration is to be condemned. Proper surgical management must include exposure of the spermatic cord in the inguinal canal, complete occlusion of all cord structures, and inspection and palpation of the lesion through an intact fascial envelope. This method of orchiectomy prevents contamination of the incision by tumor and permits manipulation without the fear of tumor embolization into the spermatic veins and lymphatic vessels, providing an excellent chance of controlling the primary tumor.4 ,
Transected testis showing normal compressed testicular tissue surmounted by I .5 cm. spherical nodule encased in fibrous capsule. Tunica albuginea is intact; at left side of open cyst is an empty hemisphere of j&rous capsule. Caseous sebaceous material which was extruded from the capsule lies at left side of capsule.
FIGURE 1.
Pathology showed only 69 cases; previously, only 30 cases had been reported.3 This lesion has distinctive pathologic characteristics including the well-defined cyst wall, a keratin-filled cyst cavity, and the absence of teratomatous elements in the specimen. Since the diagnosis cannot be
UROLOGY
/ MAY1975
I VOLUMEV.
NUMBER5
50 North Medical Drive Salt Lake City, Utah 84132 References MOSTOFI, F. K., and PRICE, E. B. : Tumors of the male genital system, Armed Forces Institute of Pathology, Washington, D.C., 1973. PRICE, E. B.: Epidermoid cysts of the testis: a clinical and pathological analysis of 69 cases from the testicular tumor registry, J. Urol. 102: 708 (1969). GILBAUGH,J. H., JR., KELALIS, P. P., and DOCKERTY, M. B.: Epidermoid cysts of the testis, ibid. 97: 876 (1967). WHITMORE, W. F., JR.: Tumors of the testis, in Campbell, M. F., and Harrison, J. H., Eds: Urology, 3rd ed., Philadelphia, W. B. Saunders Co., 1970.
697
