Cystic Testicular Lesion in an Infant: Diagnostic and Therapeutic Considerations
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Sep 30, 2019
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Abstract
Introduction: Prepuberal testicular tumors are usually benign. Cystic lesions constitute a wide group of scrotal benign masses differentials in children. An appropriate evaluation comprises a complete clinical exam, Doppler ultrasonography and tumor markers. If a benign lesion is likely, testis-sparing surgery is the treatment of choice. Objective: To describe the case of an infant with a cystic testicular mass compatible with epidermoid cyst. Furthermore, to discuss the most relevant clinical, diagnostic and therapeutic aspects of prepubertal testicular lesions. Case report: An infant was admitted due to identification of a painless well-defined testicular mass of approximately 1 cm of diameter. Ultrasonography showed an intraparenchymal simple cyst and tumor markers were negative. Complete enucleation was performed via scrotal approach without postoperative complications. Histopathological study was compatible with a testicular epidermoid cyst. There was no evidence of recurrence or atrophy at 3-year follow-up. Discussion and conclusion: Since most prepuberal testicular tumors are benign, testis-sparing surgery constitutes a therapeutic alternative in small, circumscribed, avascular lesions with negative tumor markers.
Keywords
Epidermoid cyst, Testicular neoplasms, Children, Doppler ultrasonographyQuiste epidermoide, Neoplasias testiculares, Niños, Ultrasonografía Doppler
References
Referencias
1. Friend J, Barker A, Khosa J, Samnakay N. Benign scrotal masses in children - some new lessons learned. J Pediatr Surg. 2016;51(10):1737-42. http://dx.doi.org/10.1016/j.jpedsurg.2016.07.016
2. Ciftci AO, Bingol-Kologlu M, Senocak ME, Tanyel FC, Buyukpamukcu M, Buyukpamukcu N. Testicular tumors in children. J Pediatr Surg. 2001 Dec;36(12):1796-801.
3. Ahmed HU, Arya M, Muneer A, Mushtaq I, Sebire NJ. Testicular and paratesticular tumours in the prepubertal population. Lancet Oncol. 2010;11(5):476-83. http://dx.doi.org/10.1016/S1470-2045(10)70012-7
4. Docal I, Crespo C, Pardo A, Prieto A, Alonso P, Calzada J. Epidermoid cyst of the testis: a case report. Pediatr Radiol. 2001;31(5):365-7.
5. Price EB. Epidermoid cysts of the testis: a clinical and pathologic analysis of 69 cases from the testicular tumor registry. J Urol. 1969;102(6):708-13. http://dx.doi.org/10.1016/S0022-5347(17)62236-5
6. Chams Anturi A, Cabrales Hessen M. Quiste epidermoide intratesticular. Urol Colomb. 2008;XVII(1):115-8.
7. J.S. Valla for the Group D’Etude en Urologie Pédiatrique. Testis-sparing surgery for benign testicular tumors in children. J Urol [Internet]. 2001;165(6 Pt 2):2280-3. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11379598
8. Smith EA, Dillman JR. Epidermoid cyst: a rare intratesticular tumor in children. Pediatr Radiol. 2010;40(8):1450. https://doi.org/10.1007/s00247-009-1421-4.
9. Alkhori NA, Barth RA. Pediatric scrotal ultrasound: review and update. Pediatr Radiol. 2017;47(9):1125-33.
10. Leal D, Fariña L, Pesqueira D, Meijide F, Quintana JL, Muller C, et al. Quiste epidermoide testicular. Actas Urol Esp. 2010;34(3):274-7.
11. Çakiroglu B, Sönmez NCC, Sinanoglu O, Ates L, Aksoy SHSHH, Özcan F, et al. Testicular epidermoid cyst. African J Paediatr Surg. 2015;12(1):89-90.
12. Arellano CMR, Kozakewich HPW, Diamond D, Chow JS. Testicular epidermoid cysts in children: Sonographic characteristics with pathological correlation. Pediatr Radiol. 2011;41(6):683-9.
13. Cho J-H, Chang J-C, Park B-H, Lee J-G, Son C-H. Sonographic and MR imaging findings of testicular epidermoid cysts. AJR Am J Roentgenol. United States; 2002 Mar;178(3):743-8.
14. Shtricker A, Silver D, Sorin E, Schreiber L, Katlowitz N, Tsivian A, et al. The value of testicular ultrasound in the prediction of the type and size of testicular tumors. Int Braz J Urol. 2015;41(4):655-60.
15. Pearse I, Shamberger C, Glick D, Abramson SJ, Gerald WR, Quaglia MP La. Testicular-sparing surgery for benign testicular tumors. Surgery. 1999;34(6):1000-3.
16. Caldwell BT, Saltzman AF, Maccini MA, Cost NG. Appropriateness for testis-sparing surgery based on the testicular tumor size in a pediatric and adolescent population. J Pediatr Urol. 2019;15(1):70.e1-70.e6. https://doi.org/10.1016/j.jpurol.2018.10.011
17. Hoag NA, Afshar K, Youssef D, Masterson JST, Murphy J, MacNeily AE. Cystic intratesticular lesions in pediatric patients. J Pediatr Surg. 2013;48(8):1773-7. http://dx.doi.org/10.1016/j.jpedsurg.2012.10.049
18. Casaccia G, Spagnoli A, Ferro F. Simple intratesticular cysts in infancy: Testis-sparing surgery by a scrotal approach. Urology. 2000;56(5):854-5.
19. Olguner M, Akgür FMM, Aktug T, Canda T, Aktuǧ T, Canda T. Testis sparing surgery for epidermoid cyst of the testis: A case report. Int Urol Nephrol. 1997;29(5):587-9.
20. Fujino J, Yamamoto H, Kisaki Y, Ishimaru Y, Uchida H, Mori Y, et al. Epidermoid cyst: Rare testicular tumor in children. Pediatr Radiol. 2004;34(2):172-4.
21. Madden-Fuentes R, Wiener JS, Ross SS, Routh JC. Partial orchiectomy for bilateral synchronous testicular masses in a prepubescent boy: A case report. Urology. 2012;80(5):1144-6. http://dx.doi.org/10.1016/j.urology.2012.04.056
22. Subik MK, Gordetsky J, Yao JL, Di Sant’Agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: Its role in preventing unnecessary orchiectomy. Hum Pathol. 2012;43(9):1514-9. http://dx.doi.org/10.1016/j.humpath.2011.11.013
23. Tröbs RB, Krauss M, Geyer C, Tannapfel A, Körholz D, Hirsch W. Surgery in infants and children with testicular and paratesticular tumours: A single centre experience over a 25-year-period. Klin Padiatr. 2007;219(3):146-51.
24. Romo Muñoz MI, Núñez Cerezo V, Dore Reyes M, Vilanova Sánchez A, González-Peramato P, López Pereira P, et al. Testicular tumours in children: Indications for testis-sparing surgery. An Pediatr. 2018;88(5):253-8.
25. Taghavi K, Hutson JM. Testicular microlithiasis and epidermoid cysts: A common pathway? Pediatr Surg Int. 2012;28(10):1041-3.
26. Manning MA, Woodward PJ. Testicular epidermoid cysts: sonographic features with clinicopathologic correlation. J Ultrasound Med. 2010;29(5):831-7.
27. Ross JH, Kay R, Elder J. Testis sparing surgery for pediatric epidermoid cysts of the testis. J Urol. 1993;149(2):353-6. http://dx.doi.org/10.1016/S0022-5347(17)36080-9.
28. Neumann DPDP, Abrams GSGS, Hight DWDW. Testicular epidermoid cysts in prepubertal children: Case report and review of the world literature. J Pediatr Surg. 1997;32(12):1786-9.
29. Wu D, Shen N, Lin X, Chen X. Prepubertal testicular tumors in China: a 10-year experience with 67 cases. Pediatr Surg Int. 2018;34(12):1339-43. http://dx.doi.org/10.1007/s00383-018-4366-6.
30. Giguere JK, Stablein DM, Spaulding JT, Mcleod DG, Paulson DF, Weiss RB. The clinical significance of unconventional orchiectomy approaches in testicular cancer: A report from the Testicular Cancer Intergroup Study. J Urol. 1988;139(6):1225-8. http://dx.doi.org/10.1016/S0022-5347(17)42873-4.
31. Ozen H, Altug U, Bakkaloglu MA, Remzi D. Significance of scrotal violation in the prognosis of patients with testicular tumours. Br J Urol. 1988;62(3):267-70.
1. Friend J, Barker A, Khosa J, Samnakay N. Benign scrotal masses in children - some new lessons learned. J Pediatr Surg. 2016;51(10):1737-42. http://dx.doi.org/10.1016/j.jpedsurg.2016.07.016
2. Ciftci AO, Bingol-Kologlu M, Senocak ME, Tanyel FC, Buyukpamukcu M, Buyukpamukcu N. Testicular tumors in children. J Pediatr Surg. 2001 Dec;36(12):1796-801.
3. Ahmed HU, Arya M, Muneer A, Mushtaq I, Sebire NJ. Testicular and paratesticular tumours in the prepubertal population. Lancet Oncol. 2010;11(5):476-83. http://dx.doi.org/10.1016/S1470-2045(10)70012-7
4. Docal I, Crespo C, Pardo A, Prieto A, Alonso P, Calzada J. Epidermoid cyst of the testis: a case report. Pediatr Radiol. 2001;31(5):365-7.
5. Price EB. Epidermoid cysts of the testis: a clinical and pathologic analysis of 69 cases from the testicular tumor registry. J Urol. 1969;102(6):708-13. http://dx.doi.org/10.1016/S0022-5347(17)62236-5
6. Chams Anturi A, Cabrales Hessen M. Quiste epidermoide intratesticular. Urol Colomb. 2008;XVII(1):115-8.
7. J.S. Valla for the Group D’Etude en Urologie Pédiatrique. Testis-sparing surgery for benign testicular tumors in children. J Urol [Internet]. 2001;165(6 Pt 2):2280-3. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11379598
8. Smith EA, Dillman JR. Epidermoid cyst: a rare intratesticular tumor in children. Pediatr Radiol. 2010;40(8):1450. https://doi.org/10.1007/s00247-009-1421-4.
9. Alkhori NA, Barth RA. Pediatric scrotal ultrasound: review and update. Pediatr Radiol. 2017;47(9):1125-33.
10. Leal D, Fariña L, Pesqueira D, Meijide F, Quintana JL, Muller C, et al. Quiste epidermoide testicular. Actas Urol Esp. 2010;34(3):274-7.
11. Çakiroglu B, Sönmez NCC, Sinanoglu O, Ates L, Aksoy SHSHH, Özcan F, et al. Testicular epidermoid cyst. African J Paediatr Surg. 2015;12(1):89-90.
12. Arellano CMR, Kozakewich HPW, Diamond D, Chow JS. Testicular epidermoid cysts in children: Sonographic characteristics with pathological correlation. Pediatr Radiol. 2011;41(6):683-9.
13. Cho J-H, Chang J-C, Park B-H, Lee J-G, Son C-H. Sonographic and MR imaging findings of testicular epidermoid cysts. AJR Am J Roentgenol. United States; 2002 Mar;178(3):743-8.
14. Shtricker A, Silver D, Sorin E, Schreiber L, Katlowitz N, Tsivian A, et al. The value of testicular ultrasound in the prediction of the type and size of testicular tumors. Int Braz J Urol. 2015;41(4):655-60.
15. Pearse I, Shamberger C, Glick D, Abramson SJ, Gerald WR, Quaglia MP La. Testicular-sparing surgery for benign testicular tumors. Surgery. 1999;34(6):1000-3.
16. Caldwell BT, Saltzman AF, Maccini MA, Cost NG. Appropriateness for testis-sparing surgery based on the testicular tumor size in a pediatric and adolescent population. J Pediatr Urol. 2019;15(1):70.e1-70.e6. https://doi.org/10.1016/j.jpurol.2018.10.011
17. Hoag NA, Afshar K, Youssef D, Masterson JST, Murphy J, MacNeily AE. Cystic intratesticular lesions in pediatric patients. J Pediatr Surg. 2013;48(8):1773-7. http://dx.doi.org/10.1016/j.jpedsurg.2012.10.049
18. Casaccia G, Spagnoli A, Ferro F. Simple intratesticular cysts in infancy: Testis-sparing surgery by a scrotal approach. Urology. 2000;56(5):854-5.
19. Olguner M, Akgür FMM, Aktug T, Canda T, Aktuǧ T, Canda T. Testis sparing surgery for epidermoid cyst of the testis: A case report. Int Urol Nephrol. 1997;29(5):587-9.
20. Fujino J, Yamamoto H, Kisaki Y, Ishimaru Y, Uchida H, Mori Y, et al. Epidermoid cyst: Rare testicular tumor in children. Pediatr Radiol. 2004;34(2):172-4.
21. Madden-Fuentes R, Wiener JS, Ross SS, Routh JC. Partial orchiectomy for bilateral synchronous testicular masses in a prepubescent boy: A case report. Urology. 2012;80(5):1144-6. http://dx.doi.org/10.1016/j.urology.2012.04.056
22. Subik MK, Gordetsky J, Yao JL, Di Sant’Agnese PA, Miyamoto H. Frozen section assessment in testicular and paratesticular lesions suspicious for malignancy: Its role in preventing unnecessary orchiectomy. Hum Pathol. 2012;43(9):1514-9. http://dx.doi.org/10.1016/j.humpath.2011.11.013
23. Tröbs RB, Krauss M, Geyer C, Tannapfel A, Körholz D, Hirsch W. Surgery in infants and children with testicular and paratesticular tumours: A single centre experience over a 25-year-period. Klin Padiatr. 2007;219(3):146-51.
24. Romo Muñoz MI, Núñez Cerezo V, Dore Reyes M, Vilanova Sánchez A, González-Peramato P, López Pereira P, et al. Testicular tumours in children: Indications for testis-sparing surgery. An Pediatr. 2018;88(5):253-8.
25. Taghavi K, Hutson JM. Testicular microlithiasis and epidermoid cysts: A common pathway? Pediatr Surg Int. 2012;28(10):1041-3.
26. Manning MA, Woodward PJ. Testicular epidermoid cysts: sonographic features with clinicopathologic correlation. J Ultrasound Med. 2010;29(5):831-7.
27. Ross JH, Kay R, Elder J. Testis sparing surgery for pediatric epidermoid cysts of the testis. J Urol. 1993;149(2):353-6. http://dx.doi.org/10.1016/S0022-5347(17)36080-9.
28. Neumann DPDP, Abrams GSGS, Hight DWDW. Testicular epidermoid cysts in prepubertal children: Case report and review of the world literature. J Pediatr Surg. 1997;32(12):1786-9.
29. Wu D, Shen N, Lin X, Chen X. Prepubertal testicular tumors in China: a 10-year experience with 67 cases. Pediatr Surg Int. 2018;34(12):1339-43. http://dx.doi.org/10.1007/s00383-018-4366-6.
30. Giguere JK, Stablein DM, Spaulding JT, Mcleod DG, Paulson DF, Weiss RB. The clinical significance of unconventional orchiectomy approaches in testicular cancer: A report from the Testicular Cancer Intergroup Study. J Urol. 1988;139(6):1225-8. http://dx.doi.org/10.1016/S0022-5347(17)42873-4.
31. Ozen H, Altug U, Bakkaloglu MA, Remzi D. Significance of scrotal violation in the prognosis of patients with testicular tumours. Br J Urol. 1988;62(3):267-70.
How to Cite
González Villarreal, L. C., Escobar Rivera, F. A., & Aljure Reales, V. de J. (2019). Cystic Testicular Lesion in an Infant: Diagnostic and Therapeutic Considerations. Universitas Medica, 60(4), 1–9. https://doi.org/10.11144/Javeriana.umed60-4.lqtl
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Case Reports