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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
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Table of Contents   
CASE REPORT
Year : 2016  |  Volume : 21  |  Issue : 1  |  Page : 36-37
 

Dermoid cyst of an undescended intra-abdominal testis with torsion: A rare case report


Department of Paediatric Surgery, Government Stanley Medical College, Chennai, Tamil Nadu, India

Date of Web Publication17-Dec-2015

Correspondence Address:
S Vivek
Plot No 3A, Palani Street Extension, Rajaji Nagar, Villivakkam, Chennai - 600 049, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.165841

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   Abstract 

We report a case of dermoid cyst in an undescended intra-abdominal testis, which presented with torsion and gangrene.


Keywords: Dermoid cyst, torsion testes, undescended testis


How to cite this article:
Senthilnathan R, Vivek S. Dermoid cyst of an undescended intra-abdominal testis with torsion: A rare case report . J Indian Assoc Pediatr Surg 2016;21:36-7

How to cite this URL:
Senthilnathan R, Vivek S. Dermoid cyst of an undescended intra-abdominal testis with torsion: A rare case report . J Indian Assoc Pediatr Surg [serial online] 2016 [cited 2019 Sep 15];21:36-7. Available from: http://www.jiaps.com/text.asp?2016/21/1/36/165841



   Introduction Top


Tumors in undescended testis are very rare and account for 10% of testicular tumors. More than 50% of them arise in the intra-abdominal testis. Benign tumors such as dermoid cyst are extremely rare in an intra-abdominal testis and even rare, is the occurrence of torsion in such testis. Dermoid cyst in an intra-abdominal testis, presenting with torsion and gangrene, has not been reported in children so far in the literature.


   Case Report Top


A 6-year-old boy presented with a history of right sided lower abdominal pain. Examination revealed nonpalpable right undescended testis. Penis and left testis were normal. An ultrasonogram examination of the abdomen revealed an ovoid hyperechoic lesion of size 4.8 cm × 3 cm in the right iliac fossa. In view of suspicion of tumor transformation, tumor markers alfa fetoprotein and beta human chorionic gonadotrophin were done and their levels were normal.

Magnetic resonance imaging (MRI) abdomen was also done because of suspected tumor transformation. The T2-weighted images (WI) revealed a 4.7 cm × 4.4 cm, well-defined hyperintense lesion situated in the pelvis, indenting the right side of the dome of bladder. Inferior wall of the lesion was hyperintense on T1 WI and hypointense on T2 WI due to a possible fatty wall. Thin septations were also found in the superior aspect of the lesion [Figure 1]. MRI confirmed the tumor in the right undescended testis.
Figure 1: Magnetic resonance imaging abdomen showing the testis

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Diagnostic laparoscopy was performed and it revealed a 4 cm × 5 cm mass arising from the right intra-abdominal testis located paravesically. The appendix and sigmoid colon were adherent to the mass. Adhesiolysis revealed the testicular mass and it had undergone torsion and gangrene. Laparoscopic excision in toto without spill was done and the specimen was removed through a right inguinal incision since 5 mm ports were used for the procedure [Figure 2]. The patient had an uneventful recovery. Macroscopic examination revealed hair in the lesion. Histopathology report confirmed the diagnosis of dermoid cyst with no viable testicular tissue.
Figure 2: Testis showing dermoid cyst

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   Discussion Top


The incidence of undescended testis in a term child is 3% and the incidence of undescended testis in a preterm child is 30%. The incidence of tumor in the undescended testis ranges from 0.05% to 1%. [1] Although benign tumors are more common than malignant tumors in children with undescended testis, the exact incidence of dermoid cyst in children is not known.

The undescended testis is more prone to torsion. [2] Torsion of the undescended testis occurs due to the development of malignancy, which causes an increase in size, weight, and promotes torsion. [3]

The most common tumor in an undescended testis is seminoma. In children, the most common tumor in an undescended testis is carcinoma in situ (CIS) which is a precursor to germ cell tumor. CIS is observed if there is an associated penile maldevelopment, abnormal karyotype, or bilateral intra-abdominal testis. [4] Cortes et al. [5] found testicular neoplasia in 7 of 182 (3.8%) children with abdominal undescended testes, abnormal external genitalia, or abnormal karyotype, but none in 1281 children was without these characteristics.

Teratomas constitute the most common benign tumor in the palpable testis. [5] Benign tumor in intra-abdominal testis is rarely reported in the literature. Dermoid cyst arising in the descended testis is rare and extremely rare is the dermoid cyst in intra-abdominal testis. The incidence of testicular dermoid cysts is rare compared with the ovarian dermoid cysts.

Dermoid cysts are benign monodermal forms of mature teratoma. [6] It has a predominant cyst that is lined by keratinizing squamous epithelium with skin appendages. The cyst may also contain elements of glial tissue, bone, teeth, or other cell types.

The MRI is a useful investigation to detect intra-abdominal testis. It also provides additional information regarding the nature of the lesion, if present. The presence of fat confirms a teratoma and the presence of tooth confirms a dermoid cyst.

Dermoid cyst of the testis can be excised with the preservation of the testis if vascular compromise has not occurred and orchidopexy can be done. In our case, this was not possible because of the torsion and gangrene. This case is reported for its rarity of dermoid cyst in an intra-abdominal torsed gangrenous testis.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Swerdlow AJ, Higgins CD, Pike MC. Risk of testicular cancer in cohort of boys with cryptorchidism. BMJ 1997;314:1507-11.  Back to cited text no. 1
    
2.
Schultz KE, Walker J. Testicular torsion in undescended testes. Ann Emerg Med 1984;13:567-9.  Back to cited text no. 2
[PUBMED]    
3.
Riegler HC. Torsion of intra-abdominal testis: An unusual problem in diagnosis of the acute surgical abdomen. Surg Clin North Am 1972;52:371-4.  Back to cited text no. 3
[PUBMED]    
4.
Pohl HG, Shukla AR, Metcalf PD, Cilento BG, Retik AB, Bagli DJ, et al. Prepubertal testis tumors: Actual prevalence rate of histological types. J Urol 2004;172(6 Pt 1):2370-2.  Back to cited text no. 4
    
5.
Cortes D, Thorup J, Petersen BL. Testicular neoplasia in undescended testes of cryptorchid boys-does surgical strategy have an impact on the risk of invasive testicular neoplasia? Turk J Pediatr 2004;46(Suppl):35-42.  Back to cited text no. 5
    
6.
Mostofi FK, Sesterhenn IA, Davis CJ Jr. Developments in histopathology of testicular germ cell tumors. Semin Urol 1988;6:171-88.  Back to cited text no. 6
    


    Figures

  [Figure 1], [Figure 2]



 

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    Abstract
   Introduction
   Case Report
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    References
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