Epidermoid cyst of the testis in Gardner's syndrome

Testicular epidermoid cysts in children: sonographic characteristics with pathological correlation

BACKGROUND

Testicular epidermoid cyst is a rare benign tumor in children. Although this entity is widely described in adults in literature, there are no large series describing the pathological and radiological findings in children. Knowledge of the sonographic features seen in children may alter surgical treatment.

OBJECTIVE

To describe the specific US characteristics of testicular epidermoid cyst in children and to correlate these findings with pathology.

MATERIALS AND METHODS

All children with pathologically proven epidermoid cyst and preoperative sonograms diagnosed at a single children's hospital between 1978 and 2008 were included. For each child, the medical records, preoperative US and pathological specimens were reviewed and correlated.

RESULTS

Eleven patients (ages 1-17 years old) met our criteria. Nine cysts had characteristic target or onion ring appearances, the youngest patient had a simple cyst-like lesion, one cyst had a heterogeneous appearance, and more than 80% of the cysts presented daughter cysts attached along the periphery of the main cyst.

CONCLUSION

In addition to the commonly described findings of the epidermoid cyst (the target and onion ring appearances), simple cysts and the presence of daughter lesions are newly described findings that point to the diagnosis of this benign entity in children.

Gardner's syndrome associated fibromas

Three patients with Gardner's syndrome having benign fibrous proliferations in the soft tissues and the oral cavity are presented. Lesions in all three patients were morphologically different. Two excised lesions in Case 1 were histologically identical to nuchal-type fibroma (NTF) and one lesion in this patient was an epidermal cyst. Case 2 had a lesion located in the soft tissues of the shoulder, which was morphologically similar to NTF and, in addition, contained mildly atypical and multinucleated fibroblastic cells. The oral lesion in Case 3 looked like a fibroma and was morphologically different from all fibrous lesions that have ever been described in Gardner's syndrome. The cases in the present report show that the term Gardner's fibroma is just a descriptive name encompassing a spectrum of morphologically different benign fibrous proliferations associated with this syndrome. Therefore, the term Gardner's fibroma should not be used as a specific name for NTF arising in patients with Gardner's syndrome as suggested in the most recent WHO classification of soft tissue and bone tumors.

Non-nuchal-type fibroma associated with Gardner's syndrome. A hitherto-unreported mesenchymal tumor different from fibromatosis and nuchal-type fibroma

We describe a unique benign mesenchymal tumor in paraspinal location in a 13-year-old patient with Gardner's syndrome. The Gardner's syndrome in this patient consisted of multiple (more than 100) polyps throughout the entire colon with most in the cecum and rectum, three osteomas in the frontal area of the skull and one in the third right rib, and multiple superficial skin tumors. One of these cutaneous tumors was excised and histologically diagnosed as an epidermal cyst. Both father and uncle of this patient suffered from Gardner's syndrome as well. Microscopically the mesenchymal tumor was histologically different from nuchal type fibroma and fibromatosis. It consisted of a diffusely-growing fibrous mass composed of dense collagenous fibers and relatively numerous, bland-looking, spindle-shaped cells. The collagen fibers had haphazard spacing with no lobular arrangement. The collagen fibers were of a very coarse quality. No entrapment of adipose tissue, skeletal muscle or peripheral nerves was seen in the lesion. Immunohistochemically the tumor was vimentin positive and smooth muscle actin, muscle-specific actin, S-100 protein, cytokeratin and desmin negative.

Nuchal-type fibroma: a clinicopathologic study of 52 cases

BACKGROUND

Nuchal-type fibroma (NTF) usually arises in the posterior aspect of the neck. Previously published reports describe only 11 cases and provide limited clinicopathologic information.

METHODS

Fifty-two examples of NTF from 50 patients were analyzed from the files of the Soft Tissue Registries of the Armed Forces Institute of Pathology in Washington, DC, and the Faculty Hospital in Pilsen, Czech Republic.

RESULTS

The age of the patients ranged from 3 to 74 years (mean, 40 years). There were 41 males and 9 females. Thirty-six NTFs were located in the posterior neck region and 16 were from extranuchal sites. Two patients had had lesions excised from both a nuchal and an extranuchal location. The mean greatest tumor dimension was 3.2 cm. Microscopically, all examples had a superficial (subcutaneous and sometimes dermal) component and consisted of paucicellular, thick bundles of lobulated collagen fibers with inconspicuous fibroblasts. Entrapped adipose tissue and traumatic neuromalike nerve proliferations were typically present. Skeletal muscle infiltration was also seen in a minority of cases. Eleven of 25 patients (44%) for whom clinical information was available reportedly had diabetes. Gardner's syndrome was documented in one patient and was possibly present in two additional individuals. During follow-up, five patients had local recurrences, but none of the recurrences were destructive and all were ultimately controlled by local reexcision.

CONCLUSIONS

NTF is a rare, tumorlike accumulation of collagen that often affects the posterior neck region but can also occur in a number of other sites. The process has a strong association with diabetes and also appears to be linked to Gardner's syndrome. Local recurrence probably reflects the persistence of local or systemic factors related to its pathogenesis.

Idiopathic calcinosis of the scrotum: histopathologic observations of fifty-one nodules

A 29-year-old man had a 2-year history of multiple, asymptomatic, firm, subcutaneous nodules on the scrotal skin, which sometimes discharged a chalky material. Fifty-one nodules were observed in the histopathologic examination, which revealed, in addition to the typical findings of idiopathic calcinosis of the scrotum, various forms of intact cysts: epidermal (some calcified), pilar (calcified), hybrid (calcified), and indeterminate cysts with diffusely calcified keratinous content and attenuated walls. A mixture of calcified keratinous material and inflammatory infiltrates was detected, with or without remnants of the cyst wall. These findings suggest that idiopathic calcinosis of the scrotum derives from the dystrophic calcification of cysts.

Embryonal carcinoma of the testis associated with familial adenomatosis coli. Report of a case

A rare case of embryonal carcinoma of the testis associated with familial adenomatosis coli is reported. The patient may serve as a case to support the hypothesis that familial adenomatosis coli is a systemic or generalized disease with tumorigenicity that is not restricted to the colon and rectum, and that a total colectomy with ileostomy is not always entirely curative.

Pilomatricoma-like changes in the epidermal cysts of Gardner's syndrome

We studied fifty-seven cutaneous cysts from seven members of a kindred with Gardner's syndrome. All of the cysts had large areas indistinguishable from ordinary epidermal cysts. In addition, twenty-one (37%) contained columns of shadow cells, similar to those of pilomatricoma, that projected into the lumina. The cells at the point of attachment of the columns to the cyst lining were often indistinguishable from the hair matrix-like, basophilic cells of pilomatricoma. In twenty-nine cysts (51%), masses of shadow cells were free within lumina, unattached to the epithelial lining. Deposits of shadow cells, associated with a giant cell reaction and often calcified, were present in the pericystic connective tissue of twenty cysts (35%). Thirty-six of the fifty-seven cysts (63%) had one or more of the foregoing features, and the changes were observed in cysts from six of the seven patients studied. Our observations and similar findings recorded in the literature suggest that pilomatricoma-like changes may be a characteristic of the epidermal cysts of an undetermined number of kindreds with Gardner's syndrome.

Epidermoid cysts of the testis: a report of three cases and an analysis of 141 cases from the world literature

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.

Epidermoid cysts of testis

Six cases of epidermoid cyst of the testis are presented. Conservative surgical treatment of this condition is discussed.

Cysts of the tunica albuginea. Report of 4 cases and review of the literature

Four cases of benign testicular cysts arising from the tunica albuginea are reported. A review of the literature yielded only 4 more instances of such lesions. Clinically, these cysts may be manifested as a tumor or painful swelling, or are discovered incidentally. In 3 cases a diagnosis of testicular carcinoma was entertained and high inguinal orchiectomies were done. The possibility of a conservative surgical approach, as followed in 1 case, is discussed. These cysts appear in the anterior and lateral aspects of the testis, show ample connection to the albuginea and are lined by a cuboidal epithelium. Gland-like inclusion were found in the fibrous cystic walls and in the albuginea. The histogenesis of these lesions is discussed and evidence for a possible origin in mesothelial rests trapped during development is presented. The differential diagnosis of cystic lesion of the tests is reviewd briefly.