- Email: [email protected]
Dermoid Cyst Arising in Testicular Tunics
'I\-rn JoURN.1-~:i OF UROLOGY Ccpyright © 1977 The '\Alilli2c1r_s & 'NiEzins Co.
DERMOID CYST ARISING IN TESTICULAR TUNICS ANTHONY A EASON*
AND
JOSEPH T. SPAULDING
From the Division of Urology, University of California School of Medicine, San Francisco, California
ABSTRACT
A rare case of a dermoid cyst in the scrotum is reported. Excision of the cyst through an inguinal incision resulted in an uneventful recovery. A dermoid cyst is an uncommon tumor that is most often encountered in the ovary and the eyelid. Less frequently, it
involves the fallopian tube 1 or the spermatic cord. 2 • 3 To our knowledge no case of a dermoid cyst originating intrascrotally has been reported previously. CASE REPORT
A routine physical examination of a 27-year-old man, who had been told 5 years before that he had a right spermatocele, disclosed an asymptomatic mass of the right lower hemiscrotum. This mass was ovoid and semi-fluctuant but it did not transmit light. On palpation it was noted to be separate from the testis but possibly attached to the globus minor of the epididymis. Exploration through a right inguinal incision revealed the tumor to be totally separate from the testis and epididymis but completely incorporated within the testicular tunics (part A of figure) from which it was easily freed by sharp dissection. Macroscopic examination showed a mass 4 cm. in diameter covered with a 0.2 cm. thick capsule with a smooth outer surface. The center of the mass was filled with a sticky yellowish white grumous substance, which contained several dark hairs (part B of figure). Microscopic examination showed a stratified squamous epithelium concystic structure lined taining keratin debris. On some sections skin appendages consisting of hair shafts and sebaceous glands were noted. COMMENT
Dermoid cysts of the spermatic cord are rare lesions. Gibson has postulated that these cysts arise from primitive ectodermal cells displaced, in the embryo from the lumbar area through the wolffian body. 4 Our case may represent a more distal migration of these cell nests to an intrascrotal position. The patient described was referred
Dr. Roger S. Kimball.
REFERENCES
1. Grimes, H. G. and Kornmesser, J. G.:
A, intrascrotal dermoid cyst at exploration is separate from testis and epididymis but incorporated within testicular tunics. B, gross appearance of sectioned tumor shows sticky (as seen on knife) yellowish-white material.
Accepted for publication November 12, 1976. *Requests for reprints: Division of Urology, A-644, University of California, San Francisco, California 94143.
the oviduct. Report of a case and review Gynec., Hi: 85, 1960. 2. Fox, RE.: Dermoid cyst of the spermatic cord. J. Michigan State Med. Soc., 15: 338, 1916. 3. Waiss, G. C.: Dermoids of the inguinal canal, with report of a case. Surg., Gynec. & Obst., 6: 350, 1908. 4. Gibson, T. E.: Tumors of the seminal vesicles and spernmtic cord. In: Urology, 3rd ed. Edited by M. F. Campbell and J. H. Harrison. Philadelphia: W. B. Saunders Co., 1970.
DERMOID CYST ARISING IN TESTICULAR TUNICS ANTHONY A EASON*
AND
JOSEPH T. SPAULDING
From the Division of Urology, University of California School of Medicine, San Francisco, California
ABSTRACT
A rare case of a dermoid cyst in the scrotum is reported. Excision of the cyst through an inguinal incision resulted in an uneventful recovery. A dermoid cyst is an uncommon tumor that is most often encountered in the ovary and the eyelid. Less frequently, it
involves the fallopian tube 1 or the spermatic cord. 2 • 3 To our knowledge no case of a dermoid cyst originating intrascrotally has been reported previously. CASE REPORT
A routine physical examination of a 27-year-old man, who had been told 5 years before that he had a right spermatocele, disclosed an asymptomatic mass of the right lower hemiscrotum. This mass was ovoid and semi-fluctuant but it did not transmit light. On palpation it was noted to be separate from the testis but possibly attached to the globus minor of the epididymis. Exploration through a right inguinal incision revealed the tumor to be totally separate from the testis and epididymis but completely incorporated within the testicular tunics (part A of figure) from which it was easily freed by sharp dissection. Macroscopic examination showed a mass 4 cm. in diameter covered with a 0.2 cm. thick capsule with a smooth outer surface. The center of the mass was filled with a sticky yellowish white grumous substance, which contained several dark hairs (part B of figure). Microscopic examination showed a stratified squamous epithelium concystic structure lined taining keratin debris. On some sections skin appendages consisting of hair shafts and sebaceous glands were noted. COMMENT
Dermoid cysts of the spermatic cord are rare lesions. Gibson has postulated that these cysts arise from primitive ectodermal cells displaced, in the embryo from the lumbar area through the wolffian body. 4 Our case may represent a more distal migration of these cell nests to an intrascrotal position. The patient described was referred
Dr. Roger S. Kimball.
REFERENCES
1. Grimes, H. G. and Kornmesser, J. G.:
A, intrascrotal dermoid cyst at exploration is separate from testis and epididymis but incorporated within testicular tunics. B, gross appearance of sectioned tumor shows sticky (as seen on knife) yellowish-white material.
Accepted for publication November 12, 1976. *Requests for reprints: Division of Urology, A-644, University of California, San Francisco, California 94143.
the oviduct. Report of a case and review Gynec., Hi: 85, 1960. 2. Fox, RE.: Dermoid cyst of the spermatic cord. J. Michigan State Med. Soc., 15: 338, 1916. 3. Waiss, G. C.: Dermoids of the inguinal canal, with report of a case. Surg., Gynec. & Obst., 6: 350, 1908. 4. Gibson, T. E.: Tumors of the seminal vesicles and spernmtic cord. In: Urology, 3rd ed. Edited by M. F. Campbell and J. H. Harrison. Philadelphia: W. B. Saunders Co., 1970.