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Journal of Pediatric Surgery (2010) 45, 20582060

www.elsevier.com/locate/jpedsurg

Dermoid cyst of the spermatic cord in children


Marcos Prada-Arias a,, Jos Antonio Ortiz-Rey b , Pilar Fernndez-Eire a ,
Margarita Montero-Snchez a , Ana Lema-Carril a , Ramiro Segade-Andrade a
a

Department of Pediatric Surgery, Complejo Hospitalario Universitario de Vigo (CHUVI), SERGAS,


36204 Vigo (Pontevedra), Spain
b
Department of Pathology, Complejo Hospitalario Universitario de Vigo (CHUVI), SERGAS, 36204 Vigo (Pontevedra), Spain
Received 15 March 2010; revised 1 May 2010; accepted 2 May 2010

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.

Most of masses located in the inguinal region in children


correspond to inguinal indirect hernias, although other
pathologic entities may be found, such as other types of
hernias, inguinal cord cysts, undescended testis, adenopathies, varicoceles, hematomas, femoral artery aneurysms,
varix or thrombophlebitis of the saphena vein, lipomas,
lymphangiomas, angiomas of the round ligament, supernumerary pectineus bursa, pedunculated uterine fibroids,
neuroblastoma metastasis, and epidermoid and dermoid
cysts [1-4]. Here, we present a case of dermoid cyst of the
spermatic cord in a 2-year-old boy. A review of the
literature reveals that our case is the youngest patient
reported so far.

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

Dermoid cyst of the spermatic cord in children

Fig. 1 Ultrasonographic view shows a well-defined and


heterogeneous cyst structure (1.62 cm in diameter), at left inguinal
area, inside the internal oblique muscle.

full of keratin (Fig. 3). The definitive diagnosis was dermoid


cyst. The patient made an uneventful recovery.

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].

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Fig. 3 Microscopic examination shows cyst lumen with keratin


(K) and lined by stratified squamous epithelium (SE) with attached
sebaceous glands (SG). (H&E, original magnification 200).

Histologically, dermoid and epidermoid cysts have a


well-differentiated wall lined by a stratified squamous
epithelium that surrounds a cavity full of keratin. The wall
of the dermoid cyst contains skin appendages as hair follicles
and sweat and sebaceous glands. Unlike the dermoid cyst,
the epidermoid cyst does not contain skin appendages in its
wall. That they do not contain structures foreign to the skin,
as cartilage, bone, respiratory, or gastrointestinal cells
separate them from the cystic benign teratomas that are
found in ovary, testicle, retroperitoneal, and sacrococcygeal
regions [1,3,5].
Dermoid cyst of the spermatic cord appear as a welldefined, nontender, mobile, and irreducible mass, and
sometimes have been interpreted as incarcerated inguinal
hernias [1,3]. It is reported in the literature that chronic
pressure by a dermoid cyst of the spermatic cord could result

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.

References
[1] Leeming R, Olsen M, Ponsky JL. Inguinal dermoid cyst presenting as an
incarcerated inguinal hernia. J Pediatr Surg 1992;27:117-8.
[2] Poenaru D, Jacobs DA, Kamal I. Unusual findings in the inguinal canal.
Pediatr Surg Int 1999;15:515-6.
[3] Salemis NS, Karagkiouzis G, Sambaziotis D, et al. Large dermoid cyst
of the spermatic cord presenting as an incarcerated hernia: a rare
presentation and literature review. Hernia 2010;14:321-3.
[4] Aslam MZ, Kheradmund F, Patel NS, et al. Dermoid cyst of the
spermatic cord: a rare cause of benign inguinal lump. Can Urol Assoc J
2009;3:E29-E30.
[5] Wegner HE, Herbst H, Dieckmann KP. Paratesticular epidermoid cyst
and ipsilateral spermatic cord dermoid cyst: case report and discussion
of pathogenesis, diagnosis, and treatment. J Urol 1994;152:2101-3.
[6] Ford Jr J, Sing S. Paratesticular dermoid cyst in 6-month-old infant.
J Urol 1998;139:89-90.
[7] Genetzakis M, Lagoudianakis EE, Papadima A, et al. Inguinal dermoid
cyst of the round ligament. A case report and review of the literature.
Clin Exp Obstet Gynecol 2006;33:249-51.
[8] Devine JC, Jones DC. Carcinomatous transformation of a sublingual
dermoid cyst. A case report. Int J Oral Maxillofac Surg 2000;29:
126-7.
[9] Agarwal S, Rishi A, Suri V, et al. Primary intracranial squamous cell
carcinoma arising in an epidermoid cyst: a case report and review of
literature. Clin Neurol Neurosurg 2007;109:888-91.