Organ Preserving Surgery in Testicular Epidermoid Cysts

Abstract

Our experience with 18 patients with simple epidermoid cysts of the testis (monodermal teratoma) is reported. In all patients the tumor was enucleated completely and 2 biopsies of the adjacent parenchyma were obtained for exclusion of associated germ cell cancer, scar or carcinoma in situ. There was no evidence of malignancy in any biopsy specimen. Preoperative evaluation included physical examination, testicular sonography, and determination of alpha-fetoprotein and beta-human chorionic gonadotropin levels. Although epidermoid cyst was strongly suggested by sonography, the ultrasonic appearance was not specific and inguinal testicular exploration was required. In 1 patient multiple epidermoid cysts of the right testis were associated with an adult teratoma containing embryonal carcinoma and choriocarcinoma of the left testicle. To our knowledge no similar case has been described in the literature. Based on our results and our experience, we consider tumor enucleation and biopsy of the adjacent parenchyma as adequate treatment for the benign epidermoid cyst. The literature concerning organ sparing surgery in testicular epidermoid cysts is reviewed.

Testicular Epidermoid Cyst

“…Epidermoid cysts of the testes was first reported by Dockerty and Priestly in 1942 [5], To date about 300 instances of occurences are reported in medical literature [3]. The lesion commonly presents in the second to fourth decades of life as a discreet nodular lesion within the testis, which enlarges slowly and painlessly.…”

“…The consensus today favours testicular conservation. Exploration of the testis is carried out by the inguinal route and the decision to sacrifice the testis is reserved pending frozen section histopathology confirming malignancy [1][2][3][4][5]8,9]. It is important on frozen section to differentiate the lesion from mature teratomas and dermoid cysts which are to be treated by an inguinal orchidectomy.…”

“…Differentiation from a testicular cancer is not easy. Till now , treatment of such a lesion has been an inguinal orchidectomy [2,3]. The case for testicular conservation in a young male with a benign testicular lesion is gaining ground in the recent years [3,4].…”

Quiste epidermoide testicular

“…Hay autores que proponen la realizació n de cirugía conservadora frente a la sospecha de quiste epidermoide, manteniendo un abordaje inguinal con clampeo atraumá tico del pedículo junto con biopsias de la lesió n y del paré nquima testicular adyacente 15,16 .…”

Intra-testicular epidermoid cyst: a rare case report with clinico-radiological dilemma

“…2,3 Itis usually unilateral, with a slightly higher prevalence in the right testis, and is composed entirely of keratin producing epithelium. 2,4,5 Although certain radiological features and negative tumour markers raise the suspicion of this lesion, its clinical diagnosis poses a major challenge to the surgeon. We describe a rare case of testicular epidermoid cyst in an elderly male presenting with unusual clinicoradiological features.…”