Organ Preserving Surgery in Testicular Epidermoid Cysts

Heidenreich, Axel; Engelmann, U.; Vietsch, H. V.; Derschum, W.

doi:10.1016/s0022-5347(01)67534-7

Cited by 78 publications

(44 citation statements)

References 45 publications

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“…First described in 1942 by Dockerty and Priestley (3), epidermoid cyst accounts for 1%-2% of all testicular lesions. The majority of patients are in the 2nd to 4th decades of life, although patient age ranges from 3 to 77 years (1,2,4). The reported cases have occurred in white and Asian persons.…”

Section: Discussionmentioning

confidence: 99%

Epidermoid Cyst of the Testis: Radiologic-Pathologic Correlation

Loya

Said²,

Grant³

2004

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A 27-year-old man was referred for ultrasonographic (US) evaluation of a painless right testicular mass. The mass had been present for 3 years and had recently increased in size. Physical examination revealed no evidence of lymphadenopathy or gynecomastia. Laboratory test results, including levels of the tumor marker serum ␤-human chorionic gonadotropin, were normal. The patient was admitted for surgery. Inguinal orchiectomy was performed, and the postoperative course was uneventful. Imaging FindingsTesticular US revealed a 1.9 ϫ 1.8 ϫ 1.9-cm solid mass within the right testis with concentric rings of hypoechogenicity and hyperechogenicity ("onion ring" appearance). The center of the mass was slightly echogenic. The surrounding parenchyma and the right epididymis were normal (Fig 1). The patient also had a normal chest radiograph. Pathologic EvaluationAt gross examination, the specimen consisted of a testis measuring 4.5 ϫ 2.5 ϫ 2 cm with an attached spermatic cord 8 cm in length. Bisection of the testis revealed a hard white lesion with concentric rings of white-yellow pastelike material within the testicular parenchyma. The lesion was well encapsulated and sharply delineated from the surrounding parenchyma (Fig 2). Figure 1. Longitudinal (a) and transverse (b) US images of the right testis show a well-circumscribed intratesticular mass (cursors) in the lower medial aspect of the testis. The mass contains alternating rings of hyperechogenicity and hypoechogenicity and has a slightly echogenic center. The surrounding testis is normal. RG f Volume 24 • Special Issue Loya et al S243

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Section: Discussionmentioning

confidence: 99%

Epidermoid Cyst of the Testis: Radiologic-Pathologic Correlation

Loya

Said²,

Grant³

2004

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“…epidermoid cysts have long been the ideal target for partial orchiectomy, being benign and often identified on ultrasonography owing to the fact they are cystic with little blood flow. Heidenreich et al 4 reported 100 patients with epidermoid cysts with 37-year follow-up; no patients experienced recurrence or distant metastases. leydig cell tumors are also essentially benign with only rare metastases.…”

Section: Management Of Benign Testicular Massesmentioning

confidence: 99%

“…3 In a large series of patients with GCT and a margin of normal testis around the tumor who underwent partial orchiectomy with meticulous spillage precautions, no seeding or carcinoma in situ (CIS) were detected. 4 CIS is the progenitor of testicular GCT and has a greater than 50% chance of progressing to a solid GCT. Furthermore, in recent years it has been recognized that benign lesions represent a significantly higher proportion of testicular masses than previously thought-approaching 50%-most probably owing to the increased use of high resolution ultrasonography that can detect smaller nonpalpable lesions.…”

Section: Introductionmentioning

confidence: 99%

Organ-sparing approaches for testicular masses

2010

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Organ-sparing approaches are currently practiced in urology for many malignancies. Partial orchiectomy of germ cell tumors (GCT) provides potential benefits over radical surgery by reducing the need for androgen substitution, lessening psychological stress, and preserving fertility, with a durable cure rate. Furthermore, many testicular lesions detected clinically or by ultrasonography will be benign, in which case radical orchiectomy represents overtreatment. Partial orchiectomy for benign lesions allows preservation of endocrine and exocrine function, and reduced risk of local recurrence. However, selection criteria are not clear and one must always be suspicious that a GCT might exist. Carcinoma in situ that remains in the salvaged testicle is a challenge to treat. Radiation therapy is an option, although there is a high chance that patients will subsequently require hormonal replacement. Partial orchiectomy should be undertaken only in selected patients--men with bilateral testicular cancer or GCT in a solitary testis--if the size and location of the mass are amenable to surgery. Informed patient consent discussing radical orchiectomy as the gold standard is mandatory, and discussion of the risks associated with CIS and its treatment, as well as the need for androgen supplementation are paramount. Alternative strategies of organ preservation, such as radiotherapy, HIFU and chemotherapy, might be appropriate treatment options in the future. However, the safety and efficacy of these procedures needs to be demonstrated in comparison with partial orchiectomy in larger and prospective studies with longer follow-up.

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“…In recent years, testicular-sparing surgery has been successfully performed in cases where the preoperative likelihood of benign disease was high. 8,9 In patients with small, malignant germ cell tumors, testicular-sparing surgery coupled with local adjuvant therapy showed good oncologic control in most cases. 10 An intraoperative frozen-section examination can accurately diagnose testicular cancer, 9 and radical orchiectomy should be performed if an equivocal lesion is found.…”

Section: Discussionmentioning

confidence: 99%

“…8,9 In patients with small, malignant germ cell tumors, testicular-sparing surgery coupled with local adjuvant therapy showed good oncologic control in most cases. 10 An intraoperative frozen-section examination can accurately diagnose testicular cancer, 9 and radical orchiectomy should be performed if an equivocal lesion is found. Because of the benign nature of testicular dermoid cysts, testis-sparing surgery can be attempted in young patients with a small tumor if the intraoperative frozen-section examination shows a benign lesion.…”

Section: Discussionmentioning

confidence: 99%

Testis-sparing surgery for a post-pubertal testicular dermoid cyst: A case report and literature review

Chiang

Shih

2011

Urological Science

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a b s t r a c tTesticular dermoid cysts are extremely rare. They are classified as benign tumors, and although a radical orchiectomy is the standard procedure for clinically suspicious malignant tumors, if the preoperative prediction is a benign lesion, testis-sparing surgery is a feasible option. We report a testicular dermoid cyst in a 27-year-old male with the clinical presentation of a painless, hard, testicular mass. Testissparing surgery was performed, and no tumor recurrence was noted during 6 months' follow-up. We review the literature on the clinicopathologic features of this rare testicular tumor and the therapeutic recommendations.

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Organ Preserving Surgery in Testicular Epidermoid Cysts

Cited by 78 publications

References 45 publications

Epidermoid Cyst of the Testis: Radiologic-Pathologic Correlation

Epidermoid Cyst of the Testis: Radiologic-Pathologic Correlation

Organ-sparing approaches for testicular masses

Testis-sparing surgery for a post-pubertal testicular dermoid cyst: A case report and literature review

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