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Cystic intratesticular lesions in pediatric patients
Nathan A Hoag1, Kourosh Afshar, David Youssef
1Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada. natman@interchange.ubc.ca
Insights
Pediatric intratesticular cysts are rare but usually benign. Conservative management is often suitable for pre-pubertal lesions, with testis sparing surgery recommended when intervention is necessary.
Area of Science:
- Pediatric Urology
- Surgical Oncology
- Developmental Biology
Background:
- Intratesticular cysts are uncommon in children.
- Testis sparing surgery is increasingly recommended for pediatric testicular lesions.
- This study reviews the management of pediatric testicular cysts.
Observation:
- Seven pediatric patients with intratesticular cysts were reviewed.
- Diagnoses included epidermoid cyst and mature cystic teratoma.
- Two cases of mature cystic teratoma showed adjacent intra-tubular germ cell neoplasia (ITGCN).
Findings:
- All identified cysts were benign.
- One cyst resolved spontaneously.
- Most cysts developed solid components requiring surgical intervention.
Implications:
- Conservative management may be appropriate for pre-pubertal testicular cysts.
- Testis sparing surgery is the preferred approach for surgical management.
- The presence of ITGCN in pre-pubertal patients presents a management challenge.
Background/Purpose:
Intratesticular cysts are a rare clinical entity in the pediatric population. Recently, testes sparing surgery has been recommended. We share our experience with the management of pediatric testicular cysts.
Methods:
A retrospective review of all pediatric patients referred for intratesticular cysts was conducted at a single pediatric institution from 2002 to 2010. Charts were evaluated for patient demographics, diagnosis, and management.
Results:
Seven patients were identified and included in this series. After partial orchiectomy, the final diagnosis in three patients was epidermoid cyst. Three further patients were diagnosed as mature cystic teratoma, with two of these demonstrating adjacent intra-tubular germ cell neoplasia (ITGCN). One cyst in the series underwent spontaneous resolution after eight months.
Conclusion:
All of the cystic lesions in our case series were benign with one undergoing complete resolution. The remainder became smaller and developed a solid component prompting surgery. The pre-pubertal findings of ITGCN in two patients raise a dilemma regarding the optimal long-term management for these patients. Initial conservative observation is an option for the majority of pre-pubertal cystic testicular lesions until such time that testis sparing surgery is deemed technically feasible. Testes sparing surgery should be advocated in those patients undergoing surgical management.
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