CYSTIC LYMPHANGIOMA: AN UNCOMMON TYPE OF SCROTAL SWELLING

By GORDON FERGUSON, F.R.C.S. Fort?icrIj, ScAiiior Registrar, Dcparrtnent of’ Urolog~:, Hcr.s/ings Ho.spiitr1.r

SCKOTAL swellings, beloved of examiners, are usually related to the testis, epididymis, or cord. Cystic lymphangioma, which is an unusual type of scrotal tumour, is an exception, being a swelling which arises in the coverings of the scrotum. A case of this uncommon condition is reported.

Case Report.-A boy of two and a half years was admitted to the Urological Department of the Hastings Hospitals. He was suffering from pain in the left side of the scrotum of some hours’ duration. The pain had come on suddenly and was severe. The scrotum had become swollen since the onset of the pain ; no swelling had been noticed previously.

On examination the left side of the scrotum was found to be enlarged, red, tender, and edematous. There was an irregular cystic mass, roughly 6 by 5 by 2 cm. in extent, adherent to the base of the left side of the scrotum; there was no extension to the right compartment of the scrotum. The nodular mass was translucent generally but there were discoloured parts which did not transilluminate. The testis and epididymis were situated above this tender swelling and were independent of it ; they were normal to clinical examination.

Support and rest for twenty-four hours did not alleviate the symptoms, and it was decided, therefore, to explore the mass.

Opc,rurion.~Explordtion was carried out through an incision in the scrotum close to the area to be investigated. The swelling proved to be a multicystic mass which was intimately adherent to the scrotal wall. The cysts were thin-walled and varied in size from a diameter of a few millimetres up to about two centimetres; though the majority contained a pale yellow fluid some cysts were filled with fresh blood and blood clot. It was obvious that recent hmnorrhage had occurred and that as a result cyst walls had ruptured, several cysts being thrown into continuity with one another. N o plane of cleavage existed between the cystic mass and the coverings of the scrotum ; sharp dissection with the knife was necessary to ensure thorough removal.

The child made a satisfactory recovery, and when seen subsequently in the Out-patient Clinic the scrotal wound was soundly healed and there was no evidence of recurrence of the mass.

Patliolog? Report (Dr James McMurray).-The specimen shows multilocular cyst structure. Microscopically the cysts are surrounded by a thin fibrous wall and lined by flattened endothelium. The walls in some areas contain irregular bundles of muscle. The features are consistent with those of a cystic lymphangioma of the scrotum (see i I lust rat ion),

This was the cause of the onset of pain and swelling.

DISCUSS ION The most recently

reported cases are two detailed by Helland and Miale (1953); these writers stated that they had found only five cases reported in the literature, their own cases thus bringing the total to seven. It is more than likely that the condition is commoner than these figures suggest. None of the cases to which Helland and Miale referred had been reported in the British literature.

The account given by Helland and Miale of the microscopical appearances of their cases agrees closely with the report on the appearances o f the present specimen. The clinical accounts also agree apart from the acute symptoms which arose due to hzniorrhage in the present case.

I n discussing the histology of their specimens Helland and Miale wrote : “ The appearance of the sections was similar to the appearance of a cystic lymphangioma occurring elsewhere with the exception that in both specimens bundles of smooth muscle, probably representing dartos muscle, were prominent features. Because of this finding, it is felt justified to conclude that the lymphangioma arises from the scrotum proper.” The intimate adherence of the lymphangioma to the scrotal wall, there being no plane of cleavage between the two, certainly supports this view, but the mere presence of plain muscle bundles, satisfying as it may be to

Cystic lymphangioma occurring in the scrotum appears to be a rarity.

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attribute these to the dartos muscle, is not conclusive proof of such an origin. Willis (1948) states that plain muscle may be a noteworthy feature in the structure of that better-known form of cystic lymphangioma, the cystic hygroma of the neck. It may well be incorrect, therefore, to account for the plain muscle fibres in the cystic lymphangioma of the scrotum by attributing to them an origin from the dartos muscle.

Low power photomicrograph showing plain muscle fibres in cyst wall.

SUMMARY 1 . A case of cystic lymphangioma of the scrotum is reported. 2. It seems that only seven cases have been reported previously. 3. Plain muscle may be a prominent feature of the microscopical appearances.

1 would like to thank Mr N. L. Shepperd, Consultant in charge of the Urological Department of the Hastings Hospitals, for permission to publish this case report.

I am indebted to Dr E. H . Bailey of the Southern Group Laboratory, Park Hospital, London, for the photomicrograph.

REFERENCES

HELLASD, N. J., and MIALE. J . B. (1953). J . Urol., 69, 708. WILLIS, R. A. (1948). “ Pathology of Turnours,” p. 712. (London : Butterworth.)

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