Benign Scrotal Tumor in a Pediatric Patient: Epididymal Cyst

Abstract

A pediatric patient of 12 years consulted for a left scrotal mass of 2 months of evolution. After suspecting a cystic content due to positive transillumination, on ultrasonography a scrotal cyst separated from the testis, of 5 cm in its maximum length, was confirmed. Due to size, parental anxiety, and the referred short evolution, excision was decided. Given the clinical radiological findings, a scrotal incision was chosen, obtaining complete excision. Biopsy confirmed the diagnosis of simple epididymal cyst (EC). ECs usually present as painless, scrotal swelling in adolescents as a result of dilatation of the efferent epididymal tubules. Many cases (up to 60%) regress spontaneously. In these, average time to involute ranges from 4 to 50 months. Although cases of cyst torsion have been described (with pain derived from ischemia and inflammation), conservative management has been suggested in the majority, both in pediatric and in adult series. Surgery is recommended in some patients, due to testicular pain or increased paratesticular mass, as was our case.

Bilateral epididymal cyst with spontaneous resolution

“…Epididymal cysts are unilocular or multilocular collection of fluid in the epididymis as a result of dilatation of efferent epididymal tubules due to tubular obstruction. 1,2 A study found that local production of proinflammatory cytokines evidenced by elevated concentrations of interleukin 8 (IL-8), interleukin 6 (IL-6) in epididymal cyst is responsible for cyst formation. 4 They usually develop in adult men and mostly unilateral.…”

“…Conservative management has been suggested in most cases although there is no consensus about the most adequate therapy of pubertal patients and the majority of these cysts involute with time 5 . The average time to complete involution varies from 4 to 50 months 2 . A study by BK Arora et al, reported that no spontaneous resolution was observed in the group of patients with cysts between 21 and 50 mm over a 1‐year follow‐up period 1 .…”

“…They are benign in nature and mostly unilateral but rarely can be bilateral. Epididymal cysts and spermatoceles on several occasions have been used reciprocally in the literature to describe the same entity 2 . They can occur at any age, and some authors found that there may be an increase in the proportion of epididymal cysts with age; previous published case reports revealed the condition to be present in about 5% of pediatric patients undergoing scrotal ultrasonography in general 3 …”

“…Epididymal cysts are collection of fluid in a single sac (unilocular) or more than one (multilocular) as a result of dilatation of efferent epididymal tubules due to tubular obstruction. 1,2 They are benign in nature and mostly unilateral but rarely can be bilateral. Epididymal cysts and spermatoceles on several occasions have been used reciprocally in the literature to describe the same entity.…”

To Evaluate the Outcome of Epididymal Cystectomy at Liaquat Medical College Hospital Jamshoro Pakistan

“…This is done with help of ultrasound and ethanol is inserted into cyst to kill the cells of cyst through catheter. Third option is excision/ removal of cyst which has least disadvantages [6].…”