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Jurnal Kista Dermoid
Jurnal Kista Dermoid
www.elsevier.com/locate/jpedsurg
Key words:
Dermoid cyst;
Spermatic cord;
Children
Abstract Most of inguinal masses in children correspond to inguinal indirect hernias, but other
pathologic entities may be found. Dermoid cysts of the spermatic cord are very rare, with only 9 clear
cases reported in the literature to date, all of them in adults. We present a case of dermoid cyst of the
spermatic cord in a 2-year-old boy, the youngest patient reported so far. Dermoid cysts of the spermatic
cord should be considered as part of the differential diagnosis of inguinal masses in children, especially
in cases of long-standing, nontender, and irreducible inguinal mass.
2010 Elsevier Inc. All rights reserved.
Corresponding author.
E-mail address: marcosprada@hotmail.com (M. Prada-Arias).
0022-3468/$ see front matter 2010 Elsevier Inc. All rights reserved.
doi:10.1016/j.jpedsurg.2010.05.007
1. Clinical case
A 2-year-old boy, without relevant medical antecedents,
was referred to our department with a left inguinal mass
detected by his mother 2 weeks before. During this period,
the child was asymptomatic, and no change in the mass was
noted. Physical examination revealed a subcutaneous,
mobile, nontender, and irreducible mass, approximately 2
cm in diameter, located at the level of the internal inguinal
ring. Ultrasonography showed a well-defined cystic mass,
1.62 cm in diameter, heterogeneous, and without vascular
flow, located inside the oblique internal muscle, suggesting
intramuscular hematoma (Fig. 1). Surgical excision was
performed for definitive diagnosis, finding a well-encapsulated yellowish cyst, within the inguinal canal next to the
inguinal internal orifice in contact with the spermatic cord
and surrounded by the internal oblique muscle. (Fig. 2).
Pathologic examination revealed a cystic wall lined by
stratified squamous cell epithelium with skin appendages
(hair follicles and sebaceous glands), surrounding a cavity
2. Discussion
Dermoid and epidermoid cysts result of the inclusion of
ectodermic tissue at time of embryonic closure of epithelial
fusion lines and neural groove during fetal development. They
can occur singly or multiply in any part of the body, although
are most common in the face, neck, and scalp. Rarely, they
can be intracranial, perispinal, intraspinal, intraabdominal,
intraoral, testicular, and paratesticular [5,6]. Dermoid cyst of
the round ligament and the spermatic cord are exceptional [7].
A review of the literature reveals 9 clear cases of dermoid cyst
of the spermatic cord, all of them in adults [1,3-5].
2059
Fig. 2 Intraoperative images. (A) Dermoid cyst (DC) surrounded by internal oblique muscle (OIM) within inguinal canal. (B) Excision of
dermoid cyst (DC) next to the spermatic cord (SC).
2060
in excessive weakening of the inguinal floor and cause a
direct hernia [3].
Ultrasonography, computer tomographic scan, and magnetic resonance imaging allow to evaluate the different
structures of the inguinal area and to establish the location
and relations of the cyst, which is useful to make the
differential diagnosis and to plan the surgical treatment, but
none of them offers characteristic findings that allow a
certain preoperative diagnosis of dermoid cyst [3].
Dermoid and epidermoid cysts are considered benign
tumors, but there are cases reported in the literature of
malignant transformation to squamous cell carcinoma in
adults with long-standing subcutaneous, intracranial, and
sublingual dermoid and epidermoid cysts [8,9]. There are no
reported cases of malignant transformation in children, but
complete surgical excision is recommended to prevent
recurrence, and pathologic examination must be always
made for definitive diagnosis [1,3-5].
We concluded that dermoid cyst of the spermatic cord
should be considered as part of the differential diagnosis of
inguinal masses in children, especially in cases of longstanding, nontender, and irreducible inguinal mass.
M. Prada-Arias et al.
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