1
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Usui K, Yamashita R, Sakura Y, Nakamura M, Shinsaka H, Matsuzaki M, Niwakawa M. Epidermoid cyst of the testis: A report of three cases. Clin Case Rep 2024; 12:e8577. [PMID: 38562579 PMCID: PMC10982114 DOI: 10.1002/ccr3.8577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 02/15/2024] [Accepted: 02/16/2024] [Indexed: 04/04/2024] Open
Abstract
Testicular epidermoid cysts have characteristic findings. Testicular tumor markers are negative in patients with epidermoid cysts. Clear margins and sole and small testicular tumors (20 mm or less) suggest the possibility of epidermoid cyst. Testicular-sparing surgery with intraoperative frozen section examination should be performed when suspecting epidermoid cysts. Testicular epidermoid cysts are rare tumors that account for 1% of all testicular tumors and are often clinically misdiagnosed as malignant lesions. We report three cases of epidermoid cysts. The chief manifestations were scrotal induration in two patients and pruritus scrotum in one. The median age of the patients was 23 years (18-30). All tumors were determined to be sole lesions (<20 mm in diameter). Testing for tumor markers in all patients revealed negative results. We could not rule out malignancy; hence, we performed high inguinal orchiectomy in all cases. Histologically, the inner walls of the cysts were lined with stratified squamous epithelium; their contents were keratinized. All patients were diagnosed with epidermoid cysts.
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Affiliation(s)
| | - Ryo Yamashita
- Division of UrologyShizuoka Cancer CenterShizuokaJapan
| | - Yuma Sakura
- Division of UrologyShizuoka Cancer CenterShizuokaJapan
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2
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Pozza C, Tenuta M, Sesti F, Bertolotto M, Huang DY, Sidhu PS, Maggi M, Isidori AM, Lotti F. Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice. Cancers (Basel) 2023; 15:5332. [PMID: 38001591 PMCID: PMC10670367 DOI: 10.3390/cancers15225332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Ultrasonography (US) represents the gold standard imaging method for the assessment of testicular lesions (TL). The gray-scale (GSUS) and color-Doppler (CDUS) ultrasound examination allow sonographers to investigate the size, margins, echotexture, and vascular features of TLs with the aim to differentiate benign from malignant lesions. Recently, the use of contrast-enhanced US (CEUS) and sonoelastography (SE) has led to further improvements in the differential diagnosis of TL. Although GSUS and CDUS are often sufficient to suggest the benign or malignant nature of the TL, CEUS can be decisive in the differential diagnosis of unclear findings, while SE can help to strengthen the diagnosis. The contemporary combination of GSUS, CDUS, CEUS, and SE has led to a new diagnostic paradigm named multiparametric US (mp-US), which is able to provide a more detailed characterization of TLs than single techniques alone. This narrative and pictorial review aimed to describe the mp-US appearance of several TLs. METHODS An extensive Medline search was performed to identify studies in the English language focusing on the mp-US evaluation of TLs. RESULTS A practical mp-US "identity card" and iconographic characterization of several benign and malignant TLs is provided herein. CONCLUSIONS The mp-US characterization of TL reported herein can be useful in daily clinical practice.
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Affiliation(s)
- Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Franz Sesti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Michele Bertolotto
- Department of Radiology, Ospedale Di Cattinara, University of Trieste, Strada di Fiume 447, 34149 Trieste, Italy;
| | - Dean Y. Huang
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Paul S. Sidhu
- Department of Imaging Sciences, Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King’s College London, London WC2R 2LS, UK; (D.Y.H.); (P.S.S.)
| | - Mario Maggi
- Endocrinology Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, 50139 Florence, Italy;
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (C.P.); (M.T.); (F.S.); (A.M.I.)
| | - Francesco Lotti
- Andrology, Female Endocrinology and Gender Incongruence Unit, Department of Experimental and Clinical Biomedical Sciences “Mario Serio”, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
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Ahmed A, Ridhorkar V, Goel D, Suryawanshi A. Unmasking the Uncommon: A Case Report of Scrotal Epidermoid Cysts in a Nine-Year-Old Boy. Cureus 2023; 15:e41045. [PMID: 37519555 PMCID: PMC10374176 DOI: 10.7759/cureus.41045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
Scrotal epidermoid cysts are rare. Intratesticular epidermoid cysts are more common than extra scrotal cysts and are the most commonest benign tumors of the testicles. Midline scrotal raphe cysts are reported, but only a few have intrapelvic extensions deep into the pelvis. A nine-year-old boy presented with a painless scrotal swelling. Magnetic resonance imaging (MRI) of the pelvis confirmed the cystic nature with an extension of the swelling up to the base of the prostate. On surgical exploration, the cyst had a tapering stalk with cranial extension up to the base of the prostate. The patient underwent an excision of the cyst and made an uneventful recovery and was asymptomatic at the end of three months of surgery. The histopathology of the lesion was typical of an epidermoid cyst. Extratesticular scrotal epidermoid cysts with pelvic extension are a rarity with less than five cases reported in the literature. Our case stands to be the youngest reported case of a scrotal epidermoid cyst based on our knowledge. Scrotal epidermoid cysts are a very rare and benign entity, and upon recognition and confirmation of the extent of spread, extratesticular scrotal cysts can safely be removed. No other management may be required with no recurrences reported.
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Affiliation(s)
| | | | - Deepak Goel
- Pediatric Surgery, KIMS-Kingsway Hospitals, Nagpur, IND
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4
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Zahoor A, Swamy R, Gogbashian A, Sharma A. Primary squamous cell carcinoma of the testis: a rare presentation. BMJ Case Rep 2022; 15:e246341. [PMID: 35459646 PMCID: PMC9036183 DOI: 10.1136/bcr-2021-246341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/04/2022] Open
Abstract
A man in his mid-70s presented with a lump in his left testicle. He had previously been treated for prostate cancer with radical radiotherapy. He was on treatment for hypertension and type 2 diabetes. An ultrasound of the testes demonstrated a solid intratesticular mass for which he underwent left orchidectomy. Histology from the orchidectomy was moderately differentiated squamous cell carcinoma (SCC), positive for cytokeratin (CK) 5/6 and p63. A positron emission tomogram (PET) scan was clear of any metastatic disease. His surveillance CT, done at 12 months, revealed mediastinal, abdominal and hilar adenopathy. Biopsy of hilar lymph nodes showed SCC and this was treated with platinum-based chemotherapy. Unfortunately, the patient died after 18 months. To our knowledge, this is the first reported case of metastatic SCC of testes with extensive spread and with platinum-refractory disease.
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Affiliation(s)
| | - Rajiv Swamy
- Histopathology, Lister Hospital, Stevenage, Hertfordshire, UK
| | - Andrew Gogbashian
- Consultant Radiologist, Paul Strickland Scanner Centre, Northwood, UK
| | - Anand Sharma
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
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5
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Abstract
PURPOSE OF REVIEW The presence of vascular solid tumors within the testicle is considered to be malignant until proven otherwise. However, it is prudent for clinicians to be aware of rare benign and malignant intratesticular lesions as management can differ from the established treatment algorithms for germ-cell tumors. RECENT FINDINGS Utilizing certain histopathologic findings can assist with the diagnosis of rare testis tumors. Often times the tumor subtypes are an important consideration in the grading and classification of the disease, which drives management. The multidisciplinary management of rare malignant testis tumors at an experienced center seems to provide optimal patient outcomes. Regardless of the primary treatment, prolonged follow-up for sex cord stromal tumors and other rare testis malignancies is advocated due to the delayed metastatic potential. SUMMARY The clinical presentation of rare benign and malignant testis tumors is often similar to that of germ-cell tumors. Likewise, imaging characteristics are also often indistinguishable. However, the management of these rare tumors is often different from the well established treatment algorithms of germ-cell tumors. To that end, it is important for the practicing urologist to be familiar with the current principles of these tumor characteristics and the management.
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6
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Prospective molecular and morphological assessment of testicular prepubertal-type teratomas in postpubertal men. Mod Pathol 2020; 33:713-721. [PMID: 31695156 DOI: 10.1038/s41379-019-0404-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023]
Abstract
In 2016, the World Health Organization classification system of testicular tumors included the new entity prepubertal-type teratoma based on its morphological and molecular profile, and the realization that these tumors may occur in postpubertal men. For treatment and prognostic purposes, it is important to distinguish prepubertal-type teratoma from the usual postpubertal-type teratoma, because the former is benign unlike the latter. The distinction may be challenging. In this study, we investigated clinical, morphological, and molecular criteria for distinguishing prepubertal-type teratoma from postpubertal-type teratoma in a prospective series of pure testicular teratomas. All cases of pure teratoma in postpubertal men assessed at Barts Health NHS Trust or in consultation since the introduction of routine investigation of chromosome 12p status in 2010 were reviewed. Morphological features suggestive of prepubertal-type teratoma were observed in 14 out of 35 cases. All underwent molecular testing and none displayed 12p amplification. Mean tumor size was 16 mm (range 7-28 mm). None had associated germ cell neoplasia in situ or significant atrophy. Four incorporated a well-differentiated neuroendocrine tumor, 1-2 mm in size. Of the ten patients with follow-up information, none have recurred or metastasized. Twenty-one of the 35 cases were diagnosed as postpubertal-type teratoma, mean tumor size 40 mm (range 6-90 mm). One case underwent molecular testing: a tumor of pure skeletal muscle differentiation and possessed 12p amplification. Three cases presented with clinical metastases. Eight cases contained immature areas, ten cases had associated germ cell neoplasia in situ, and 17 cases had severe atrophy of the parenchyma. One case with neither germ cell neoplasia in situ nor atrophy showed necrosis. We conclude that both morphological and molecular features are of help in differentiating prepubertal-type teratoma from postpubertal-type teratoma. In nearly all postpubertal-type teratomas, molecular testing was unnecessary, and merely confirmed the morphological impression in the prepubertal-type teratomas. Our study confirmed the high incidence of well-differentiated neuroendocrine tumors in the prepubertal-type.
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7
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Liu R, Li A, Jiang Y, Ji J, Yu S, Chen N. MRI findings of an atypical testicular epidermoid cyst: A case report. Medicine (Baltimore) 2020; 99:e18818. [PMID: 32011491 PMCID: PMC7220063 DOI: 10.1097/md.0000000000018818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Typical testicular epidermoid cysts (TECs) manifestate as a target sign or onion skin sign on ultrasonography and magnetic resonance (MR) imaging. Clinicians are increasingly aware of the imaging characteristics of typical TECs, which allow accurate diagnosis and successful treatment while preserving the testicle, but atypical TECs are likely to be misdiagnosed as a malignant intratesticular neoplasm, leading to complete testicular resection. PATIENT CONCERNS A 26 year-old male patient complained of a painless enlargement of the left testicle that had been present for 1 month. The patient had no recent medical history of scrotal trauma or systemic infection. DIAGNOSIS A round 48 mm × 45 mm × 43 mm mass was seen inside the left testicle. T2-weighted images of the lesion showed a thin hypointense capsule. T1-weighted images of the lesion showed a hyperintense nodule on the cyst wall, which appeared hypointense on T2-weighted and SPAIR images. After Gd-DTPA injection, the lesion was not enhanced; however, the nodule was enhanced on THRIVE images. These manifestations were consistent with a benign intratesticular lesion, and MR imaging diagnosed atypical TEC, which was confirmed by pathology after surgery. INTERVENTIONS The patient was treated with organ-sparing surgery with testicular enucleation. OUTCOMES The patient was re-examined with ultrasonography 3 months after surgery. The left residual testicular tissue appeared normal, and reproductive function was preserved. CONCLUSION Urologists must be aware of the clinical and MR imaging characteristics of atypical TECs and the utility of preoperative MR imaging for the diagnosis of testicular lesions to ensure that organ-sparing surgery is performed rather than unnecessary orchiectomy.
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Affiliation(s)
- Renwei Liu
- Urogenital System Group, Department of Radiology
| | - Aibo Li
- Urogenital System Group, Department of Radiology
| | | | - Jiayin Ji
- Urogenital System Group, Department of Radiology
| | | | - Nengxue Chen
- Department of Ultrasonography, People's Hospital of Long Hua District, Shenzhen, China
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8
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Squamous Cell Carcinoma Developing from a Testicular Epidermal Cyst: A Case Report and Literature Review. Case Rep Urol 2019; 2019:9014301. [PMID: 31019832 PMCID: PMC6451811 DOI: 10.1155/2019/9014301] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/15/2019] [Accepted: 03/03/2019] [Indexed: 11/30/2022] Open
Abstract
A 50-year-old Japanese man with a two-year history of a painless right scrotal mass visited our hospital. Considering laboratory findings and computed tomography, the patient was diagnosed with an uncharacteristic testicular tumor. No metastases were present on radiographic study at the first visit. Emergent high radical orchiectomy was performed, and the tumor was identified as a squamous cell carcinoma (SCC) of a testicular epidermal cyst. He is alive without recurrence or metastasis six months after surgery. Testicular SCC is an extremely rare tumor. This is the third case of testicular SCC associated with an epidermal cyst in English literature.
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9
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Ghazle H, Apeland T. Epidermoid Cyst of the Testis: Sonographic Characteristic Appearance. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479318805451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Intratesticular epidermoid cysts are rare, benign, well-defined, and solitary keratinized intratesticular lesions. They usually present as a painless, discrete, and firm swollen area before being diagnosed. Preoperative diagnosis of epidermoid cysts is often difficult. Sonography is a useful imaging modality in the preoperative assessment of testicular lesions. Although it is difficult to distinguish epidermoid cysts from germ cell tumors, certain sonographic characteristics such as the classical “onion-peel” appearance, the negative tumor markers, and the underlying symptoms should raise the suspicion of epidermoid cysts.
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Affiliation(s)
- Hamad Ghazle
- Rochester Institute of Technology, College of Health Sciences and Technology, Rochester, NY, USA
| | - Tracy Apeland
- University of Rochester Medical Center, Imaging Sciences/Ultrasound, Rochester, NY, USA
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10
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Takeshima T, Yamamoto M, Takamoto D, Mochizuki T, Kuroda S, Kawahara T, Izumi K, Teranishi JI, Miyoshi Y, Otani M, Uemura H, Yumura Y. High orchiectomy and ipsilateral testicular sperm extraction in a man with a testicular tumor and Klinefelter syndrome: A case report. IJU Case Rep 2018; 2:65-68. [PMID: 32743375 PMCID: PMC7292169 DOI: 10.1002/iju5.12037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 11/20/2018] [Indexed: 11/12/2022] Open
Abstract
Introduction Testicular epidermal cysts in Klinefelter syndrome are very rare. We report a case of Klinefelter syndrome associated with a testicular epidermal cyst. To our knowledge, this is the first report showing successful spermatozoa retrieval from the affected testis. Case presentation A 25-year-old married man was referred to our hospital with right scrotal induration, which was in lower pole of the right testis. Testicular cancer tumor markers were normal; endocrinological findings indicated hypergonadotropic hypogonadism. Semen analyses revealed azoospermia. Preoperative chromosome test result: 47, XXY karyotype; ultrasonography report: 1.9-cm internal heterogeneous echoic mass in the right testis (malignancy not discarded). Because the patient hoped for children, he underwent high orchiectomy with ipsilateral testicular sperm extraction (200 spermatozoa from normal testicular tissue) for future fertilization procedures. Tumor pathology was an epidermal cyst. Conclusion While performing orchiectomy for testicular tumors, sperm retrieval should be attempted from normal tissues in patients planning for children.
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Affiliation(s)
- Teppei Takeshima
- Department of Urology Reproduction Center Yokohama City University Medical Center Yokohama Japan
| | - Mizuki Yamamoto
- Department of Urology Reproduction Center Yokohama City University Medical Center Yokohama Japan
| | - Daiji Takamoto
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Taku Mochizuki
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Shinnosuke Kuroda
- Department of Urology Reproduction Center Yokohama City University Medical Center Yokohama Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Koji Izumi
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Jun-Ichi Teranishi
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Masako Otani
- Department of Pathological Diagnosis Yokohama City University Medical Center Yokohama Kanagawa Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation Yokohama City University Medical Center Yokohama Japan
| | - Yasushi Yumura
- Department of Urology Reproduction Center Yokohama City University Medical Center Yokohama Japan
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11
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Case of testicular epidermoid cyst: Sonographic and histopathologic findings. JOURNAL OF SURGERY AND MEDICINE 2018. [DOI: 10.28982/josam.408567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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12
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Abstract
Benign intratesticular lesions such as epidermoid cyst are rare, but recognition is important to avoid unnecessary surgical intervention (orchiectomy). The combination of ultrasonographic findings and negative tumour markers can help differentiate benign from malignant intratesticular lesions. At surgery, the lesion can be enucleated and frozen sections obtained to confirm the diagnosis, thus avoiding the need for orchiectomy.
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Affiliation(s)
- LTH Tan
- Precious Blood Hospital, Department of Radiology, 113 Castle Peak Road, Sham Shui Po, Kowloon, Hong Kong
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13
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Marko J, Wolfman DJ, Aubin AL, Sesterhenn IA. Testicular Seminoma and Its Mimics: From the Radiologic Pathology Archives. Radiographics 2017; 37:1085-1098. [PMID: 28574809 DOI: 10.1148/rg.2017160164] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Testicular seminoma is the most common malignant tumor of the testis. It classically manifests as a painless mass. Radiologic evaluation with high-frequency ultrasonography (US) is critical for diagnosis. Seminomas are usually homogeneously hypoechoic masses at US. In challenging cases, magnetic resonance (MR) imaging may help confirm that a mass is intratesticular and provide data for local staging. Computed tomography (CT) provides valuable information for staging, including the presence and size of retroperitoneal lymph nodes. Testicular seminoma is treated with radical inguinal orchiectomy and is highly curable even at advanced stages of disease. Several neoplastic and nonneoplastic conditions may mimic testicular seminoma at imaging. Benign mimics include segmental infarction, hematoma, infection, epidermoid cyst, adrenal rests, sarcoidosis, splenogonadal fusion, and sex cord-stromal tumors. Malignant mimics include nonseminomatous germ cell tumors, lymphoma, and metastases. These conditions are individually reviewed with emphasis on features that allow differentiation from seminoma. Spermatocytic tumor, formerly known as spermatocytic seminoma, accounts for only 1% of testicular tumors. It is distinct from classic seminoma, with unique histologic, molecular, and genetic features. It affects an older patient population than classic seminoma and demonstrates indolent clinical behavior. Radiologists serve a key role in diagnosis, staging, and surveillance of patients with seminoma. A thorough knowledge of related clinical, radiologic, and pathologic findings will help the radiologist contribute to high-quality interdisciplinary care of affected patients.
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Affiliation(s)
- Jamie Marko
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Darcy J Wolfman
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Alex L Aubin
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
| | - Isabell A Sesterhenn
- From the Department of Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Md (J.M.); American Institute for Radiologic Pathology, 1100 Wayne Ave, Suite 1020, Silver Spring, MD 20910 (J.M., D.J.W.); Department of Radiology, Johns Hopkins School of Medicine, Washington, DC (D.J.W., A.L.A.); and Joint Pathology Center, Silver Spring, Md (I.A.S.)
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14
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Abstract
Testicular epidermoid cysts are a rare cause of testicular pathology. No cases of recurrence or metastasis have been reported in the literature. As a result, inguinal partial orchiectomy with frozen section has recently become standard treatment. A 43-year-old male presented with right testicular discomfort and the presence of mass. Right inguinal partial orchiectomy with frozen section was performed, and the right testicle was preserved. The final pathology report confirmed the diagnosis of an epidermoid cyst. The importance of accurate diagnosis of this benign lesion is crucial for the prevention of unnecessary radical orchiectomy.
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Affiliation(s)
- Kenan B Ashouri
- Department of Urology, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Joshua M Heiman
- Department of Urology, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Emily F Kelly
- Department of Urology, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton Regional Hospital, Boca Raton, FL, USA
| | - Angelos N Manganiotis
- Department of Urology, Florida Atlantic University, Charles E. Schmidt College of Medicine, Boca Raton Regional Hospital, Boca Raton, FL, USA
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15
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Kondo T, Kawahara T, Matsumoto T, Yamamoto Y, Tsutsui M, Ohtani M, Ohtaka M, Kumano Y, Maeda Y, Mochizuki T, Mori K, Asai T, Kuroda S, Takeshima T, Hattori Y, Teranishi JI, Miyoshi Y, Yumura Y, Yao M, Inayama Y, Uemura H. Epidermal Cyst in the Scrotum Successfully Treated while Preserving the Testis: A Case Report. Case Rep Oncol 2016; 9:235-40. [PMID: 27194984 PMCID: PMC4868926 DOI: 10.1159/000445826] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
A 66-year-old male was referred to our hospital for further examination of a scrotal mass. Because of the risk of testicular cancer, we first clamped the vessels as a course of higher orchiectomy. Then, we approached the tumor through the scrotum and successfully resected it while preserving the testis. A histopathological diagnosis revealed an epidermal cyst. We herein report a rare case of an intrascrotal epidermal cyst successfully treated while preserving the testis.
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Affiliation(s)
- Takuya Kondo
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
- *Takashi Kawahara, MD, Department of Urology and Renal Transplantation, Yokohama City University Medical Center, 4-57, Urafune-cho, Minami-ku Yokohama (Japan), E-Mail
| | - Taro Matsumoto
- Department of Pathological Diagnosis, Yokohama City University Medical Center, Yokohama, Japan
| | - Yuko Yamamoto
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Miho Tsutsui
- Department of Urology, Yokohama Toho Hospital, Yokohama, Japan
| | - Masako Ohtani
- Department of Urology, Yokohama Toho Hospital, Yokohama, Japan
| | - Mari Ohtaka
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yohei Kumano
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yoko Maeda
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Taku Mochizuki
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Kohei Mori
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takuo Asai
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Shinnosuke Kuroda
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Teppei Takeshima
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yusuke Hattori
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Jun-ichi Teranishi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasuhide Miyoshi
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Yasushi Yumura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yoshiaki Inayama
- Department of Pathological Diagnosis, Yokohama City University Medical Center, Yokohama, Japan
| | - Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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Patil V, Shetty SMC, Das S. Common and Uncommon Presentation of Fluid within the Scrotal Spaces. Ultrasound Int Open 2015; 1:E34-40. [PMID: 27689151 DOI: 10.1055/s-0035-1555919] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 06/29/2015] [Indexed: 01/18/2023] Open
Abstract
Ultrasonography(US) of the scrotum has been demonstrated to be useful in the diagnosis of fluid in the scrotal sac. Grayscale US characterizes the lesions as testicular or extratesticular and, with color Doppler, power Doppler and pulse Doppler, any perfusion can also be assessed. Cystic or encapsulated fluid collections are relatively common benign lesions that usually present as palpable testicular lumps. Most cysts arise in the epidydimis, but all anatomical structures of the scrotum can be the site of their origin. US may suggest a specific diagnosis for a wide variety of intrascrotal cystic and fluid lesions and appropriately guide therapeutic options. The paper reviews the current knowledge of ultrasound in conditions with fluid in the testis and scrotum. The review presents the applications of ultrasonography in the diagnosis of hydrocele, testicular cysts, epididymal cysts, spermatoceles, tubular ectasia, hernia and hematoceles. The aim of this paper is to provide a pictorial review of the common and uncommon presentation of fluid within the scrotal spaces.
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Affiliation(s)
- V Patil
- Radiodiagnosis, JSS Medical College, Mysore, India
| | - S M C Shetty
- Radiodiagnosis, JSS Medical College, Mysore, India
| | - S Das
- Radiodiagnosis, JSS Medical College, Mysore, India
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17
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Sharma P, Dhillon J, Sexton WJ. Intratubular Germ Cell Neoplasia of the Testis, Bilateral Testicular Cancer, and Aberrant Histologies. Urol Clin North Am 2015. [PMID: 26216815 DOI: 10.1016/j.ucl.2015.04.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intratubular germ cell neoplasia (ITGCN) is a precursor lesion for testicular germ cell tumors, most of which are early stage. ITGCN is also associated with testicular cancer or ITGCN in the contralateral testis, leading to a risk of bilateral testicular malignancy. Testicular biopsy detects most cases, and orchiectomy is the treatment of choice in patients with unilateral ITGCN. Low-dose radiation therapy is recommended in patients with bilateral ITGCN or ITGCN in the solitary testis, but the long-term risks of infertility and hypogonadism need to be discussed with the patient. Rare histologies of primary testicular cancer are also discussed.
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Affiliation(s)
- Pranav Sharma
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Jasreman Dhillon
- Department of Genitourinary Anatomic Pathology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL 33612, USA.
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18
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Bilateral Epidermoid Cysts of the Testes: A Characteristic Appearance on Ultrasonography. Ultrasound Q 2015; 31:205-7. [PMID: 25699512 DOI: 10.1097/ruq.0000000000000141] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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19
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Ulbright TM, Young RH. Testicular and paratesticular tumors and tumor-like lesions in the first 2 decades. Semin Diagn Pathol 2014; 31:323-81. [DOI: 10.1053/j.semdp.2014.07.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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20
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Ketabchi AA. Epidermoid Cyst of the Testis in a 6 -Years-Old Boy With Increased Serum LDH. INTERNATIONAL JOURNAL OF SCHOOL HEALTH 2014. [DOI: 10.17795/intjsh-19853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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21
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Domínguez A, Casanova G, Hannaoui N, Banús JM. Quiste epidermoide testicular. Rev Int Androl 2012. [DOI: 10.1016/s1698-031x(12)70072-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Abstract
We present the case of a boy with antenatally diagnosed bilateral testicular microlithiasis. Following annual surveillance the child developed metachronous bilateral epidermoid cysts. These were subsequently excised with testicular sparing surgery. Currently, there are only three cases of bilateral epidermoid cysts in the paediatric population, and none have been associated with testicular microlithiasis. This reignites the discussion regarding the histogenesis of epidermoid cysts and how its pathophysiology might relate to testicular microlithiasis.
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Epidermal Inclusion Cyst Presenting as a Palpable Scrotal Mass. Case Rep Urol 2012; 2012:498324. [PMID: 23094187 PMCID: PMC3474240 DOI: 10.1155/2012/498324] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 09/15/2012] [Indexed: 11/17/2022] Open
Abstract
We report a scrotal epidermal inclusion cyst located outside the median raphe which a rare entity in the absence of trauma and few cases have been reported. 47 year old male presents with a complaint of right sided testicular swelling and discomfort. On examination a 3 cm mass was palpated between the scrotum and the medial thigh on the subcutaneous tissue with a positive slip sign. Complete surgical excision of the cyst was performed. Histopathology confirmed epidermal inclusion cyst with no evidence of malignancy.
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25
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Patel K, Sellars ME, Clarke JL, Sidhu PS. Features of testicular epidermoid cysts on contrast-enhanced sonography and real-time tissue elastography. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2012; 31:115-122. [PMID: 22215776 DOI: 10.7863/jum.2012.31.1.115] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A series of 7 testicular epidermoid cysts were imaged by contrast-enhanced sonography to assess internal vascularity and by real-time tissue elastography to grade stiffness by a visual and strain ratio quantification scoring system. No internal vascular enhancement was seen on contrast-enhanced sonography; the 3 largest lesions showed rim enhancement. On the real-time elastographic color display, all lesions were predominantly blue ("hard"), and the lesions analyzed for the strain ratio had a mean value of 43.57. Contrast-enhanced sonography depicts the absence of vascular flow, and real-time elastography shows that the epidermoid cysts are hard. This combination of information will help further characterize these lesions.
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Affiliation(s)
- Ketul Patel
- Department of Radiology, King's College London, King's College Hospital, London, England
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26
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Geraghty MJ, Lee FT, Bernsten SA, Gilchrist K, Pozniak MA, Yandow DJ. Sonography of Testicular Tumors and Tumor-Like Conditions: A Radiologic-Pathologic Correlation. ACTA ACUST UNITED AC 2011. [DOI: 10.3109/10408379891244163] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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27
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Wijnands M. Multiple epidermoid cysts in the testis of a New Zealand White rabbit: a case report. ACTA ACUST UNITED AC 2011; 64:873-4. [PMID: 21515036 DOI: 10.1016/j.etp.2011.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2011] [Accepted: 03/29/2011] [Indexed: 11/28/2022]
Abstract
Multiple epidermoid cysts were observed microscopically in the testis of a New Zealand White rabbit. The cysts were lined by stratified squamous keratinizing epithelium and filled with concentric layers of keratin. Testicular epidermoid cysts have been described in men but are very rare in animals.
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Affiliation(s)
- Marcel Wijnands
- Department of Toxicology & Applied Pharmacology, TNO Triskelion, Utrechtseweg 48, PO Box 844, 3700 AV, Zeist, The Netherlands.
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28
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Makari JH, Ramachandra P, Ferrer FA. Pediatric urologic oncology: organ-sparing surgery in kidney and testis. Urol Clin North Am 2010; 37:287-98. [PMID: 20569806 DOI: 10.1016/j.ucl.2010.03.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Technological advances in imaging as well as increased knowledge of tumor-specific biology have promoted the role of organ-sparing approaches to pediatric renal and testicular tumors. Application of these techniques continues to evolve as data on long-term follow-up become available and as protocol-guided investigation provides answers to therapeutic outcomes of these approaches. Optimally, organ-sparing surgery will continue to provide increased potential for preservation of both renal function and fertility.
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Affiliation(s)
- John H Makari
- Department of Surgery, University of Connecticut School of Medicine, Farmington, CT 06030, USA
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30
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Manning MA, Woodward PJ. Testicular epidermoid cysts: sonographic features with clinicopathologic correlation. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:831-837. [PMID: 20427796 DOI: 10.7863/jum.2010.29.5.831] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
OBJECTIVE The purpose of this series was to describe the sonographic features of intratesticular epidermoid cysts with clinicopathologic correlation. METHODS A retrospective review of the sonographic features of all intratesticular epidermoid cysts within the radiologic pathology archive of the Armed Forces Institute of Pathology with correlation with clinical, surgical, and pathologic data was performed. On sonograms, intratesticular epidermoid cysts were evaluated for shape, borders, and the presence of characteristic features, including alternating hypoechoic and hyperechoic rings, mural calcifications, and echogenic central core. Color Doppler imaging was evaluated for the presence of internal flow. RESULTS Of 21 cysts seen in 20 male patients (mean age, 24 years; range, 11-52 years), the most common finding was mural calcifications, which were seen in 18 lesions (86%). Concentric rings of alternating echogenicity were shown in 13 lesions (62%), and 7 cysts (33%) had an echogenic central core. No cysts showed internal vascularity. CONCLUSIONS Testicular epidermoid cysts are uncommon solid-appearing testicular masses that usually present as palpable masses and are benign. Knowledge of the sonographic and pathologic features may help differentiate these lesions from malignancy and possibly prevent unnecessary orchiectomy.
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Affiliation(s)
- Maria A Manning
- Department of Radiology, University of Maryland Medical Center, Baltimore, MD 21201, USA.
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31
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Kim NR, Cho HY, Yoon SJ, Park JH, Ha SY. Primary squamous cell carcinoma in the testis: a case report. J Korean Med Sci 2010; 25:634-7. [PMID: 20358011 PMCID: PMC2844585 DOI: 10.3346/jkms.2010.25.4.634] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2008] [Accepted: 11/13/2008] [Indexed: 11/30/2022] Open
Abstract
A 51-yr-old man presented with an enlarged right testis for two months. The radically resected testis showed a relatively well-circumscribed ovoid mass, nearly replacing the normal architecture with central cystic changes. Microscopically, the mass was composed of ovoid shaped tumor cells of a moderately differentiated squamous cell carcinoma (SCC). The central portion of the mass was filled with well-formed laminated keratinous materials and the remnant cavity lined by dysplastic squamous epithelium, indicated SCC may be derived from an epidermal cyst. SCC is among the most common types of neoplasm afflicting human beings, but it is rare in the testis. To our knowledge, this is the second report of the testicular squamous cell carcinoma occurring in a patient without other primary tumors, and the firstly reported case in Korea.
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Affiliation(s)
- Na Rae Kim
- Department of Pathology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Hyun Yee Cho
- Department of Pathology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Sang Jin Yoon
- Department of Urology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
| | - Jae Hong Park
- Department of Forensic Medicine, National Institute of Scientific Investigation, Seoul, Korea
| | - Seung Yeon Ha
- Department of Pathology, Gachon University of Medicine and Science, Gil Medical Center, Incheon, Korea
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32
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33
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Hernandez RJ, Buadu A. Case report of a testicular epidermoid cyst and review of its typical sonographic features. J Radiol Case Rep 2010; 4:18-23. [PMID: 22470754 DOI: 10.3941/jrcr.v4i9.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
A case of testicular epidermoid cyst, demonstrating multiple characteristic sonographic patterns in a single lesion, is presented with a brief review of the distinctive ultrasound features. It is important to remember that the sonographic patterns describing testicular epidermoids represent the varied amounts and arrangements of keratin of a particular lesion. A given lesion may demonstrate subtle variability or more than one characteristic pattern at any given time. With this in mind, preoperative characterization of testicular epidermoids should allow for increasing utilization of testicular sparring surgery in the management of this benign lesion.
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Affiliation(s)
- Ryan James Hernandez
- Department of Radiology, University of Arizona College of Medicine, Tucson, Arizona, USA
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34
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Smith AK, Hansel DE, Klein EA. Epidermoid Cyst of the Testicle. Urology 2009; 74:544. [DOI: 10.1016/j.urology.2009.04.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2009] [Revised: 04/05/2009] [Accepted: 04/14/2009] [Indexed: 11/25/2022]
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35
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Ali TZ, Parwani AV. Benign and Malignant Neoplasms of the Testis and Paratesticular Tissue. Surg Pathol Clin 2009; 2:61-159. [PMID: 26838100 DOI: 10.1016/j.path.2008.08.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Benign and malignant tumors of the testes and paratesticular tissues present an interesting spectrum of diagnostic entities often encountered in routine surgical pathology practice. Germ cell tumors are the most common tumors of the testes and, despite a rising incidence, have excellent prognosis because of their radiosensitivity and/or effective chemotherapeutic agents. The proper classification of these tumors aids in the choice of appropriate treatment options. This article reviews benign and malignant neoplastic entities of the testes and paratesticular tissues and illustrates the classic pathologic characteristics. The differential diagnosis, along with ancillary studies, clinical significance, and presentation are discussed also.
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Affiliation(s)
- Tehmina Z Ali
- Department of Pathology, University of Maryland Medical Center, NBW47, 22 S. Greene Street, Baltimore, MD 21201, USA.
| | - Anil V Parwani
- Pathology Informatics, Shadyside Hospital, University of Pittsburg Medical Center, 5230 Centre Avenue, Suite WG02.10, Pittsburgh, PA 15232, USA
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36
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Abstract
We describe the case of a 13-year-old boy with testicular epidermoid cyst who presented with a painless testicular mass. Epidermoid cyst of the testis is a benign, non-teratomatous tumor. It is often possible to make the diagnosis preoperatively, combining typical sonographic features with normal biochemical tumor markers. Preoperative diagnosis will allow for testis-sparing surgery and prevent unnecessary orchiectomy.
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37
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Affiliation(s)
- Saleem A. Umar
- Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
| | - Gregory T. MacLennan
- Department of Pathology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, Ohio
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38
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Kim W, Rosen MA, Langer JE, Banner MP, Siegelman ES, Ramchandani P. US–MR Imaging Correlation in Pathologic Conditions of the Scrotum. Radiographics 2007; 27:1239-53. [PMID: 17848688 DOI: 10.1148/rg.275065172] [Citation(s) in RCA: 164] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Ultrasonography (US) is usually the initial imaging modality for evaluation of pathologic conditions of the scrotum. However, magnetic resonance (MR) imaging can be useful as a problem-solving tool when sonographic findings are equivocal. MR imaging allows characterization of scrotal masses as intratesticular or extratesticular and can demonstrate various types of lesions and tissue, including cysts or fluid, solid masses, fat, and fibrosis. MR imaging may be of value when the location of a scrotal mass is uncertain or when US does not allow differentiation between a solid mass and an inflammatory or vascular abnormality. Gadolinium-enhanced MR imaging can help differentiate between a benign cystic lesion and a cystic neoplasm. Gadolinium-enhanced imaging can also be used to demonstrate areas of absent or reduced testicular perfusion, such as in segmental testicular infarct. Finally, MR imaging can demonstrate an intraabdominal undescended testis, which can be difficult to detect with US, and is superior to US in differentiation between an undescended testis and testicular agenesis.
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Affiliation(s)
- Woojin Kim
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
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39
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Stewart VR, Sidhu PS. The testis: the unusual, the rare and the bizarre. Clin Radiol 2007; 62:289-302. [PMID: 17331822 DOI: 10.1016/j.crad.2006.10.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Revised: 10/12/2006] [Accepted: 10/22/2006] [Indexed: 11/21/2022]
Abstract
Ultrasound is the preferred technique when imaging the scrotal contents. Although appearances of many of the more common abnormalities present the examiner with no diagnostic difficulty, the more unusual conditions may present a considerable challenge. Many normal variants, unusual and rare abnormalities may be instantly recognized once seen. The current review highlights the more unusual and rare conditions affecting the scrotal contents in order to allow the reader the opportunity to gain knowledge of their existence and to aid future interpretation of the difficult examination.
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Affiliation(s)
- V R Stewart
- Department of Radiology, King's College Hospital, London, UK
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40
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Abstract
The great variety of non germinal testis tumours and their rarity explain the difficulties of a specific therapeutic management. The analysis of the most important varieties of tumours allows identifying an overall trend in both diagnosis and therapy.
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41
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Cheng L, Zhang S, MacLennan GT, Poulos CK, Sung MT, Beck SD, Foster RS. Interphase fluorescence in situ hybridization analysis of chromosome 12p abnormalities is useful for distinguishing epidermoid cysts of the testis from pure mature teratoma. Clin Cancer Res 2006; 12:5668-72. [PMID: 17020968 DOI: 10.1158/1078-0432.ccr-06-0976] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The distinction of epidermoid cyst of the testis from teratoma is of critical importance because the former is benign and the latter is a malignant tumor that may have associated metastasis of either teratomatous or non-teratomatous germ cell tumor types. Chromosome 12p abnormalities are seen in the vast majority of testicular germ cell tumors of adults and are present in all histologic subtypes. In this study, we investigated the clinical utility of interphase fluorescence in situ hybridization (FISH) analysis of chromosome 12p abnormalities for distinguishing epidermoid cysts of the testis from pure mature teratoma. EXPERIMENTAL DESIGN Sixteen testicular epidermoid cysts and 17 testicular teratomas were investigated for isochromosome 12p [i(12p)] and 12p overrepresentation using interphase FISH analysis. RESULTS Neither i(12p) nor 12p overrepresentation were observed in 16 epidermoid cyst cases, whereas i(12p) was detected in 76% of teratomas and 12p overrepresentation was identified in 29% of teratomas. Overall, 88% of testicular teratomas had chromosome 12p abnormalities. CONCLUSIONS FISH identification of i(12p) and/or 12p overrepresentation in routinely processed surgical specimens is a useful ancillary diagnostic tool in distinguishing testicular epidermoid cysts from teratoma.
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Affiliation(s)
- Liang Cheng
- Departments of Pathology and Laboratory Medicine, Indiana University School of Medicine, 350 West 11th Street, Indianapolis, IN 46202, USA.
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42
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Affiliation(s)
- Ali Uzunlar
- Department of Pathology, Dicle University, Diyarbakir, Turkey.
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43
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44
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Yoshida T, Takao T, Tsujimura A, Tomita H, Aozasa K, Okuyama A. Testicular epidermoid cyst in Klinefelter's syndrome. Int J Urol 2006; 13:478-80. [PMID: 16734882 DOI: 10.1111/j.1442-2042.2006.01331.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
A 38-year-old Japanese man was referred to our outpatient clinic for treatment of infertility. Semen analysis showed azoospermia. Chromosome analysis revealed a 47XXY karyotype, and non-mosaic Klinefelter's syndrome (KFS) was diagnosed. Upon physical examination, the patient's right testicular volume was 30 mL and the left testicular volume was 3 mL. Laboratory tests showed normal levels of lactate dehydrogenase, alpha-fetoprotein, and human chorionic gonadotropin beta-subunit. The plasma luteinizing hormone and follicle-stimulating hormone levels were increased to 15.7 mIU/mL and 45.9 mIU/mL, respectively. The plasma testosterone was decreased to 0.25 ng/mL. Magnetic resonance imaging showed a right testicular mass of low-signal intensity on the T1-weighted image and of high-signal intensity on the T2-weighted image. Therefore, the final diagnosis was KFS with a right testicular tumor. Thus, a right high orchiectomy was performed. Histological examination revealed an epidermoid cyst of the right testis. Epidermoid cysts in cases of KFS are rare. To our knowledge, only seven cases, including ours, have been reported in the literature.
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Affiliation(s)
- Takahiro Yoshida
- Department of Urology, Osaka University Graduate School of Medicine, Suita, Japan.
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Kaya C, Pirincci N, Kanberoglu H, Yilmazgumrukcu G, Karaman MI. Sparing surgery for an epiderom cyst of the testis: a case report and literature review. Kaohsiung J Med Sci 2005; 21:424-6. [PMID: 16248127 DOI: 10.1016/s1607-551x(09)70145-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Epidermoid cyst of the testis is relatively rare and accounts for less than 1% of all testicular neoplasms. This condition usually occurs in young men and it is mostly detected by self-examination or routine physical examination. The case of a 27-year-old male with an epidermoid cyst of the testis is discussed. The diagnosis was based on ultrasonography and management was with testicular-sparing surgery. At 2-year follow-up, the patient had had no relapse or metastasis. In epidermoid cysts of the testis, high-frequency ultrasonography is a reliable diagnostic imaging method. Organ-preserving surgery is recommended in the management of these lesions.
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Affiliation(s)
- Cevdet Kaya
- Department of Urology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey.
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46
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Maizlin ZV, Belenky A, Baniel J, Gottlieb P, Sandbank J, Strauss S. Epidermoid cyst and teratoma of the testis: sonographic and histologic similarities. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:1403-9; quiz 1410-1. [PMID: 16179625 DOI: 10.7863/jum.2005.24.10.1403] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
OBJECTIVE The classic sonographic description of an epidermoid cyst is a mass with a target or onion ring appearance of alternating rings of hyperechogenicity and hypoechogenicity. This study presents a pathologic-sonographic assessment of classic and nonclassic appearances of an epidermoid cyst of the testis and reports the possible similarity between a classic epidermoid cyst and a teratoma on sonography. METHODS We reviewed the sonographic and histologic features of 8 testicular tumors that either had a classic onion ring pattern or were found at pathologic examination to be epidermoid cysts but did not have the classic sonographic pattern. RESULTS Three epidermoid cysts had a typical onion ring appearance. Histologic sections of these tumors revealed a squamous epithelial layer lining the cyst and multiple concentric laminated layers of keratin. Two tumors did not have a typical sonographic appearance of epidermoid cysts but were found to be epidermoid cysts at pathologic examination. One was homogeneously hypoechoic, and the other had irregular cystic and solid components, but neither had a target or onion ring appearance. Histologically, both of these tumors consisted of cystic cavities lined by squamous epithelium and contained desquamated keratinized epithelium. Notably, 3 other tumors pathologically diagnosed as teratomas had a sonographic appearance of classic epidermoid cysts. These tumors contained layers of keratin, but the cyst was lined by both squamous cells (ectodermal origin) and cylindrical epithelium (endodermal origin), thereby precluding the diagnosis of epidermoid cysts. CONCLUSIONS There is considerable overlapping of the sonographic appearances of teratomas and epidermoid cysts of the testis. Although the onion ring appearance of an intratesticular tumor is suggestive of an epidermoid cyst, this appearance may also be found in cases of a teratoma. Whereas the former condition can be treated by local enucleation, the latter requires radical orchiectomy.
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Affiliation(s)
- Zeev V Maizlin
- Department of Radiology, Assaf Harofeh Medical Center, Zerifin 70300, Israel.
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47
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Omar MA, Ochai J, Natarajan C, Makunde J, Close P. Epidermoid cyst in a solitary testis: A case for non-surgical management. Surgeon 2004; 2:352-3. [PMID: 15712577 DOI: 10.1016/s1479-666x(04)80036-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
This is a case report of a 71-year-old man who presented with an incidental finding of a mass in a solitary right testis. A scrotal ultrasound scan showed the typical features of a testicular epidermoid cyst. Tumour markers were not elevated and the patient was managed non-operatively. On reviewing the literature, we found no previous report on the non-operative management of testicular epidermoid cysts
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Affiliation(s)
- M A Omar
- Department of Urology, Wexham Park Hospital, Slough, Berkshire UK
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Loya AG, Said JW, Grant EG. Epidermoid Cyst of the Testis: Radiologic-Pathologic Correlation. Radiographics 2004; 24 Suppl 1:S243-6. [PMID: 15486244 DOI: 10.1148/rg.24si035223] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Alma G Loya
- Department of Radiology, University of California at Los Angeles, USA
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Parwani AV, Epstein JI, Ali SZ. Pathologic quiz case: a 2-month-old male infant with a large hydrocele. Epidermoid cyst of the scrotum. Arch Pathol Lab Med 2004; 128:e135-6. [PMID: 15387685 DOI: 10.5858/2004-128-e135-pqcamm] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Anil V Parwani
- Department of Pathology and Radiology, The Johns Hopkins Hospital, Baltimore, Md 21287, USA
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50
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Pérez-Guillermo M, García-Solano J, Sánchez-Sánchez C, Montalbán-Romero S, Acosta-Ortega J. Diagnostic limitations in testicular cytopathology: To what extent is fine-needle aspiration reliable for the diagnosis of epidermoid cyst of the testis? Diagn Cytopathol 2004; 31:83-6. [PMID: 15282718 DOI: 10.1002/dc.10404] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This article describes the cytologic and histologic findings of a epidermoid cyst of the testis diagnosed by means of fine-needle aspiration (FNA) cytology. The gross and cytologic features are creamy aspirate, squamous cells, squamae, and fragments of granulomatous tissue. The cytologic features are fairly typical and similar to those observed in cutaneous epidermoid cysts; however, in this setting, the differential diagnosis should be carried out mainly with teratoma and dermoid cysts. The patient's age and precise location of the mass are paramount in the differential diagnosis. We believe that FNA is a reliable tool for the diagnosis of testicular epidermoid cysts, but the differential diagnosis with dermoid cysts should be based on histology.
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