Lesión quística testicular en un lactante: consideraciones diagnósticas y terapéuticas
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sep 30, 2019
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Resumen
Introducción: Los tumores testiculares prepuberales suelen ser benignos. Las lesiones quísticas constituyen un amplio diagnóstico diferencial de las masas benignas escrotales en niños. Una adecuada evaluación incluye el examen clínico, la ecografía Doppler y la medición de marcadores tumorales. Ante una fuerte sospecha clínica y radiológica de benignidad, el tratamiento de elección es la enucleación con preservación del parénquima. Objetivo: Describir el caso de un lactante con una masa quística de testículo compatible con quiste epidermoide. Discutir los aspectos clínicos, imagenológicos y terapéuticos más relevantes de las lesiones testiculares prepuberales. Presentación del caso: Un lactante ingresa por identificación de una masa testicular circunscrita no dolorosa de 1 cm de diámetro. La ecografía demuestra un quiste simple intraparenquimatoso y los marcadores tumorales son negativos. Se realiza enucleación por vía escrotal, sin complicaciones. El estudio histopatológico es compatible con un quiste epidermoide. Hubo seguimiento a 3 años sin recidiva ni atrofia testicular. Discusión y conclusión: Teniendo en cuenta que la mayoría de los tumores prepuberales de testículo son benignos, la cirugía conservadora puede considerarse una alternativa terapéutica ante una lesión circunscrita, pequeña, avascular, con marcadores tumorales negativos.
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.
Cómo citar
González Villarreal, L. C., Escobar Rivera, F. A., & Aljure Reales, V. de J. (2019). Lesión quística testicular en un lactante: consideraciones diagnósticas y terapéuticas. Universitas Medica, 60(4), 1–9. https://doi.org/10.11144/Javeriana.umed60-4.lqtl
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