Dermoid cyst of the spermatic cord: a rare cause of benign inguinal lump

Abstract

Dermoid cyst of the spermatic cord is an extremely rare pathology seen at the urological clinic. We present the case of a 26-year-old man who presented with a groin lump, thought to be a lipoma or a hydrocoele of the cord. The final histopathological analysis established the diagnosis of a dermoid cyst. Can Urol Assoc J 2009;3(4):E29-E30 Case reportA 26-year-old man presented to our urology clinic with a history of a mass in the right groin, which had been present for as long as he could remember. More recently he found this mass increasingly uncomfortable and felt that it interfered with his job. He was an otherwise healthy with no history of cryptorchidism or inguinal hernias.On examination his abdomen was soft and nontender. There were no hernias or cough impulses in the inguinal region. Both testes were normal. In the right inguinal canal there was a 6-cm nontender fluctuant lump that was slightly transilluminable. An ultrasound showed the presence of a right groin mass consisting of 2 separate large cystic lesions with internal echoes within the inguinal canal. These measured 8 × 2.5 cm and 10 × 4.5 cm. There were no reported sonographic features to suggest an underlying malignancy. The patient underwent an exploration of the right spermatic cord with the differential diagnosis of a lipoma or an encysted hydrocoele of the cord.During surgery we noted 2 soft masses, each the size of a small orange, within the inguinal canal. They appeared separate from the cord, and we felt they contained fat. We excised both masses ( Fig. 1 and Fig. 2).Multiple histopathological sections from the cord lesions showed thin-walled cystic structures containing inspissated keratin and lined by mature keratinising squamous epithelium. The wall contained skin appendage structures with both eccrine glands and sebaceous glands. There was no evidence for dysplasia or malignancy in the lining of the cyst. The surrounding fatty connective tissue contained no residual or atrophic testicular tissue. The histological appearances suggested a dermoid cyst (Fig. 3). The patient had an uneventful recovery. DiscussionPatients with groin swellings can present to the urologist in the outpatient clinic. Though the most common diagnosis is an inguinal hernia, other causes of groin swellings include femoral hernias, hydrocoeles, undescended testis, enlarged lymph nodes, lipoma, femoral artery aneurysm, saphena

Dermoid of spermatic cord diagnostic dilemma

“…patients with groin swelling, the first diagnosis would be inguinal hernia [4] . other causes of groin swelling includes hydrocele, femoral hernia, undesended testes, femoral lymph node, lipoma of cord, spermatocele, femoral artery aneurysm, sephena varix, varicocele, thrombophelbitis of long sephanous vein [5] .…”

Dermoid of spermatic cord diagnostic dilemma

“…4 other causes of groin swelling includes hydrocele, femoral hernia, undesended testes, femoral lymph node, lipoma of cord, spermatocele, femoral artery aneurysm, sephena varix, varicocele, thrombophelbitis of long sephanous vein. 5 Dermoid cyst of spermatic cord is a rare cause of groin swelling till now 11 cases reported to date.…”