Background: In this study, we aimed to share our experiences in patients with epidermoid cyst of the testis. We report the demographic and clinical characteristics and the long term results in patients with epidermoid cysts. Materials and Methods: Thirteen patients with epidermoid cyst of the testis treated between June 2000 and January 2018 were retrospectively evaluated. Ten patients with available data were included in the study. Patients’ age, scrotal localization of symptoms, physical examination findings, serum tumor marker levels, pathology results and follow-up periods were recorded. Results: The current cohort consisted of 10 patients. The mean age at diagnosis was 29.7 years (range, 20 to 53 years). Eighty percent of the lesions were localized to the left hemiscrotum and 20% to the right hemiscrotum. One patient had a history of unilateral undescended testis. Serum tumor markers were normal in all patients. The mean scrotal mass lesion volume at diagnosis was 28 mm 3 (range, 13 to 51 mm 3). The mean follow-up period was 66.9 months (range, 12 to 216 months). Conclusions: Epidermoid cyst of the testis should be kept in mind, particularly in patients with lesions negative for tumor markers and radiological findings typical of epidermoid cysts. Annual follow-up is not required.
Epidermoid cyst of the testis is a benign simple epithelial tumor and an uncommon lesion that accounts for about 1% of all testicular masses [
Thirteen patients with epidermoid cyst of the testis treated in Sultan Abdulhamid Han Training and Research Hospital, Umraniye Training and Research Hospital and Harran University Research Hospital between June 2008 and June 2018 were included in the study. The data were collected retrospectively. No ethical committee approval was required, owing to the retrospective nature of our study.
The current cohort included 10 patients with available data. Patients over 18 years of age with epidermoid cysts and available data were included in the study. The exclusion criteria included age under 18 years, suspected malignant pathology and unavailability of data.
The patients’ medical records were reviewed. Patients’ data including age, initial complaints (such as scrotal pain, swelling, mass or infertility), location of tumor (the right or left testis), smoking habit, history of undescended testis, family history, preoperative lactate dehydrogenase (LDH), alpha-fetoprotein (AFP) and β-human chorionic gonadotrophin (β-HCG) levels, diagnostic imaging findings, pathology results and follow-up time were evaluated.
For all scrotal masses; each testicle was examined with both hands. All patients were routinely evaluated with scrotal ultrasonography. Contrast-enhanced magnetic resonance imaging was performed if required. Testicular mass volume was measured using the following formula: length (L) × width (W) × height (H) × 0.52 [
All testicular materials were macroscopically sampled and the sections of each case were examined by uropathologists. The tissue samples were processed in a tissue processor overnight. The tissues were embedded in paraffin blocks and multiple recuts were made from the blocks. Then, the staining process was performed. The surgical specimens of testicular tissues were examined histologically with routine hematoxylin-eosin (H&E) staining.
Demographic characteristics of the patients were recorded and possible etiologic factors were identified. Radiological and pathological differential diagnoses were evaluated. The reasons for possible recurrences or relapses that may occur in the follow-up period were planned to be investigated.
In the analysis of the data, the descriptive statistics were presented as means (minimum-maximum) for continuous variables. Discontinuous variables were defined as present or absent.
For the 10 patients included in the analyses, the mean age was 29.7 years (range, 20 to 53 years). In 8 of 10 patients who admitted with testicular mass, lesions were located on the left side of the scrotum, while they were located on the right side in 2 patients. One patient presented with scrotal pain (10%). Three patients had scrotal swelling (30%). Three patients had both scrotal pain and swelling (30%). Three patients with a testicular mass presented with a painless lump (30%). Of the patients, 70% were smokers or tobacco users. However, no possible etiologic factors were found. One patient (10%) had been followed up with the diagnosis of undescended testis in childhood but no surgical treatment was performed. None of the patients had a family history of epidermoid cyst. In all patients, the preoperative mean β-hCG, AFP and LDHisoenzyme levels were normal and 1.16 mIU/ml, 1.24 ng/ml, and 265.44 U/l, respectively. All patients underwent inguinal orchiectomy. Pathological results of all cases were reported as testicular epidermoid cyst. The mean testicular mass volume was 28 mm3 (range, 13 to 51 mm3). Mean follow-up period was 66.9 months (range, 12 to 216 months). No recurrent cases were detected during the follow-up period (
Testicular epidermoid cysts are rare benign lesions of the testis [
Variable | Mean (Min - Max) |
---|---|
Age (years) | 29.7 (20 - 53) |
Size of Cyst (mm3) | 28 (13 - 51) |
Follow-Up (month) | 66.9 (12 - 216) |
Recurrence (n) | 0 |
[
The main theory of embryological development is monodermal development of a teratoma. Another theory suggests that it originates from metaplasia of squamous epithelium [
Testicular epidermoid cysts can be seen in childhood as well as in adults. Wu et al. [
Most patients are asymptomatic and scrotal pain, scrotal swelling, painless mass or a combination of these symptoms may be found in the medical history [
The size of the testicular mass affects the testicular symptoms. Paffenholz et al. [
In general, the lesions are round or oval and are heterogeneous without vascularity or blood flow on ultrasonography of the scrotum (
although epidermoid cysts have typical findings, it is not always possible to distinguish them from other scrotal lesions.
Testicular germ cell tumors, testicular teratomas, dermoid cysts, tuberculosis and focal testicular hemorrhage should be considered in radiological differential diagnosis. Testicular germ cell tumors tend to show vascularity, testicular teratomas have a similar appearance and are distinguished by histopathological examination and tunica albuginea cysts tend to be completely anechoic [
In histopathological microscopic examination, epidermoid cyst of the testis is lined by squamous epithelium with a granular layer, fibrous wall and lamellar keratinization in the lumen (
Testicular epidermoid cysts are rare lesions and there is not enough information in the literature recurrence and follow-up. There are limited preoperative findings that help distinguish epidermoid cysts from testicular tumors. In recent years, testicular sparing surgery has been more commonly recommended and performed, especially in patients with lesions that are negative for tumor markers and that have radiological findings typical of epidermoid cysts. Annual
follow-up is not required since there is no risk of recurrence.
The limitations of our study include its retrospective nature and the small number of patients with testicular epidermoid cyst. However, it should be noted that the incidence of the disease is extremely low.
The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
Ediz, C., Ihvan, A., Kati, B., Akan, S. and Yilmaz, O. (2019) Epidermoid Cyst of the Testis 5-Year Follow-Up Results in Adults. Open Journal of Urology, 9, 69-76. https://doi.org/10.4236/oju.2019.94008