No abstract

Epidermoid cysts of the testis are rare and represent about 1% of all testicular tumors. An analysis of 141 cases reported to date in the world literature, including the cases reported here, indicates that 50% of the lesions occur in the third decade and 86% between the second and fourth decade. The most common presentations are painless enlargement of the testis (41%) for an average period of 2.25 years or incidental detection during routine physical examination (33%). Clinically, a discrete testicular nodule can be palpated in the majority of the cases (76%). Pathologic findings are those of a squamous lined cyst containing keratin with absence of appendages or other elements. It is believed that, despite the benign nature of the lesion, they should be treated by orchiectomy so that a thorough pathologic examination can be done to establish a confident diagnosis. While some controversy exists about their source of origin, all the evidence, including the age, more common occurrence among whites, and the rare reported cases arising in cryptorchid testis points to a germ cell origin for these lesions. The epidermoid cyst should thus be recognized as another subtype in the category of germ cell tumors of the testis and perhaps the ovary.Cancer 47577-582, 1981. H E MAJORITY O F TESTICULAR TUMORS, nearly 95%T of them, are germ cell in origin, and almost all of these are malignant. The rarer, benign tumors of the testis are accounted for mainly by tumors of the specialized gonadal stroma, the supporting connective tissue, the dermoid, and epidermoid cysts. While the dermoid cyst, analogous to its more common counterpart in the ovary, is extremely rare in the testis, it appears from the scattered reports that epidermoid cysts may not be all that rare.29 In fact, it is estimated that epidermoid cysts represent about 1% of all testicular tumors and are perhaps as common as the benign interstitial tumor of the t e s t i~.~~~"~~ We report three cases of epidermoid cysts of the testis, which were seen within a two-year period at Georgetown University Medical Center. A review of other cases reported in the world literature delineates the clinical and pathologic features and offers further evidence on their likely origin. Case Reports Case IA 24-year-old white male consulted a physician after he felt enlargement of the right testis. Physical examination revealed a slight swelling of the right epididymis and also a 1 cm painless and nontender mass in the left testis. The patient denied any knowledge of the mass but admitted to a history of gonorrhea 2% years previously. Due to a suspicion of a testicular tumor, a left orchiectomy with high ligation of the cord was carried out. Exploration of the right side showed a cyst ofthe epididymis that was opened and drained. Three-and-a-half years later, the patient is alive and well.Pathologic examination showed a well-circumscribed 1.1 cm nodule within the testicular parenchyma, filled with flaky, yellow-white material. Part of the wall was calcified. Microscopically, the cyst was fil...

Clinical data suggest that large radiation fractions are biologically superior to smaller fraction sizes in prostate cancer radiotherapy. The CyberKnife is an appealing delivery system for hypofractionated radiosurgery due to its ability to deliver highly conformal radiation and to track and adjust for prostate motion in real-time. We report our early experience using the CyberKnife to deliver a hypofractionated stereotactic body radiation therapy (SBRT) boost to patients with intermediate-to high-risk prostate cancer. Twenty-four patients were treated with hypofractionated SBRT and supplemental external radiation therapy plus or minus androgen deprivation therapy (ADT). Patients were treated with SBRT to a dose of 19.5 Gy in 3 fractions followed by intensity modulated radiation therapy (IMRT) to a dose of 50.4 Gy in 28 fractions.Quality of life data were collected with American Urological Association (AUA) symptom score and Expanded Prostate Cancer Index Composite (EPIC) questionnaires before and after treatment. PSA responses were monitored; acute urinary and rectal toxicities were assessed using Common Toxicity Criteria (CTC) v3. All 24 patients completed the planned treatment with an average follow-up of 9.3 months. For patients who did not receive ADT, the median pre-treatment PSA was 10.6 ng/ml and decreased in all patients to a median of 1.5 ng/ml by 6 months post-treatment. Acute effects associated with treatment included Grade 2 urinary and gastrointestinal toxicity but no patient experienced acute Grade 3 or greater toxicity. AUA and EPIC scores returned to baseline by six months post-treatment. Hypofractionated SBRT combined with IMRT offers radiobiological benefits of a large fraction boost for dose escalation and is a well tolerated treatment option for men with intermediate-to high-risk prostate cancer.Early results are encouraging with biochemical response and acceptable toxicity. These data provide a basis for the design of a phase II clinical trial.

No abstract

Epidermoid cysts of the testis are rare and represent about 1% of all testicular tumors. An analysis of 141 cases reported to date in the world literature, including the cases reported here, indicates that 50% of the lesions occur in the third decade and 86% between the second and fourth decade. The most common presentations are painless enlargement of the testis (41%) for an average period of 2.25 years or incidental detection during routine physical examination (33%). Clinically, a discrete testicular nodule can be palpated in the majority of the cases (76%). Pathologic findings are those of a squamous lined cyst containing keratin with absence of appendages or other elements. It is believed that, despite the benign nature of the lesion, they should be treated by orchiectomy so that a thorough pathologic examination can be done to establish a confident diagnosis. While some controversy exists about their source of origin, all the evidence, including the age, more common occurrence among whites, and the rare reported cases arising in cryptorchid testis points to a germ cell origin for these lesions. The epidermoid cyst should thus be recognized as another subtype in the category of germ cell tumors of the testis and perhaps the ovary.