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spermatic cord in a 2-year-old boy, the youngest patient reported so far. Dermoid cysts of the spermatic

lated yellowish cyst, within the inguinal canal next to theinguinal internal orifice in contact with the spermatic cordand surrounded by the internal oblique muscle. (Fig. 2).Pathologic examination revealed a cystic wall lined bystratified squamous cell epithelium with skin appendages

Journal of Pediatric Surgery (2010) 45, 20582060 Corresponding author.correspond to inguinal indirect hernias, although otherpathologic entities may be found, such as other types ofhernias, inguinal cord cysts, undescended testis, adenopa-thies, varicoceles, hematomas, femoral artery aneurysms,varix or thrombophlebitis of the saphena vein, lipomas,lymphangiomas, angiomas of the round ligament, supernu-merary pectineus bursa, pedunculated uterine fibroids,neuroblastoma metastasis, and epidermoid and dermoidcysts [1-4]. Here, we present a case of dermoid cyst of thespermatic cord in a 2-year-old boy. A review of theliterature reveals that our case is the youngest patientreported so far.

A 2-year-old boy, without relevant medical antecedents,was referred to our department with a left inguinal massdetected by his mother 2 weeks before. During this period,the child was asymptomatic, and no change in the mass wasnoted. Physical examination revealed a subcutaneous,mobile, nontender, and irreducible mass, approximately 2cm in diameter, located at the level of the internal inguinalring. Ultrasonography showed a well-defined cystic mass,1.62 cm in diameter, heterogeneous, and without vascularflow, located inside the oblique internal muscle, suggestingintramuscular hematoma (Fig. 1). Surgical excision wasperformed for definitive diagnosis, finding a well-encapsu-0dMost of masses locatedcord should be considered as part of the differential diagnosis of inguinal masses in children, especiallyin cases of long-standing, nontender, and irreducible inguinal mass. 2010 Elsevier Inc. All rights reserved.

in the inguinal region in children 1. Clinical caseSpermatic cord;pathologic entities may be found. Dermoid cysts of the spermatic cord are very rare, with only 9 clearcases reported in the literature to date, all of them in adults. We present a case of dermoid cyst of theDermoid cyst of the spermatMarcos Prada-Arias a,, Jos Antonio OrtizMargarita Montero-Snchez a, Ana Lema-CaDepartment of Pediatric Surgery, Complejo Hospitalario U36204 Vigo (Pontevedra), SpainbDepartment of Pathology, Complejo Hospitalario Universita

Received 15 March 2010; revised 1 May 2010; accepted 2 May 20

Key words:Dermoid cyst;

Abstract Most of inguinal mE-mail address: marcosprada@hotmail.com (M. Prada-Arias).

022-3468/$ see front matter 2010 Elsevier Inc. All rights reserved.oi:10.1016/j.jpedsurg.2010.05.007cord in childrenyb, Pilar Fernndez-Eire a,il a, Ramiro Segade-Andrade a

rsitario de Vigo (CHUVI), SERGAS,

e Vigo (CHUVI), SERGAS, 36204 Vigo (Pontevedra), Spain

in children correspond to inguinal indirect hernias, but other

www.elsevier.com/locate/jpedsurg(hair follicles and sebaceous glands), surrounding a cavity

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

A review of the literature reveals 9 clear cases of dermoid cyst

Histologically, dermoid and epidermoid cysts have a

Fig. 1 Ultrasonographic view shows a well-defined andheterogeneous cyst structure (1.62 cm in diameter), at left inguinalarea, inside the internal oblique muscle.

Fig. 3 Microscopic examination shows cyst lumen with keratin(K) and lined by stratified squamous epithelium (SE) with attachedsebaceous glands (SG). (H&E, original magnification 200).

2059Dermoid cyst of the spermatic cord in childrenof the spermatic cord, all of them in adults [1,3-5].cyst. The patient made an uneventful recovery.

2. Discussion

Dermoid and epidermoid cysts result of the inclusion ofectodermic tissue at time of embryonic closure of epithelialfusion lines and neural groove during fetal development. Theycan occur singly or multiply in any part of the body, althoughare most common in the face, neck, and scalp. Rarely, theycan be intracranial, perispinal, intraspinal, intraabdominal,intraoral, testicular, and paratesticular [5,6]. Dermoid cyst ofthe round ligament and the spermatic cord are exceptional [7].Fig. 2 Intraoperative images. (A) Dermoid cyst (DC) surrounded by indermoid cyst (DC) next to the spermatic cord (SC).well-differentiated wall lined by a stratified squamousepithelium that surrounds a cavity full of keratin. The wallof the dermoid cyst contains skin appendages as hair folliclesand sweat and sebaceous glands. Unlike the dermoid cyst,the epidermoid cyst does not contain skin appendages in itswall. That they do not contain structures foreign to the skin,as cartilage, bone, respiratory, or gastrointestinal cellsseparate them from the cystic benign teratomas that arefound in ovary, testicle, retroperitoneal, and sacrococcygealregions [1,3,5].

Dermoid cyst of the spermatic cord appear as a well-defined, nontender, mobile, and irreducible mass, andsometimes have been interpreted as incarcerated inguinalhernias [1,3]. It is reported in the literature that chronicpressure by a dermoid cyst of the spermatic cord could resultternal oblique muscle (OIM) within inguinal canal. (B) Excision of

in excessive weakening of the inguinal floor and cause adirect hernia [3].

Ultrasonography, computer tomographic scan, and mag-netic resonance imaging allow to evaluate the differentstructures of the inguinal area and to establish the locationand relations of the cyst, which is useful to make thedifferential diagnosis and to plan the surgical treatment, butnone of them offers characteristic findings that allow acertain preoperative diagnosis of dermoid cyst [3].

Dermoid and epidermoid cysts are considered benigntumors, but there are cases reported in the literature ofmalignant transformation to squamous cell carcinoma inadults with long-standing subcutaneous, intracranial, andsublingual dermoid and epidermoid cysts [8,9]. There are noreported cases of malignant transformation in children, butcomplete surgical excision is recommended to preventrecurrence, and pathologic examination must be alwaysmade for definitive diagnosis [1,3-5].

We concluded that dermoid cyst of the spermatic cordshould be considered as part of the differential diagnosis ofinguinal masses in children, especially in cases of long-standing, nontender, and irreducible inguinal mass.

References

[1] Leeming R, Olsen M, Ponsky JL. Inguinal dermoid cyst presenting as anincarcerated 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 cystof the spermatic cord presenting as an incarcerated hernia: a rarepresentation and literature review. Hernia 2010;14:321-3.

[4] Aslam MZ, Kheradmund F, Patel NS, et al. Dermoid cyst of thespermatic cord: a rare cause of benign inguinal lump. Can Urol Assoc J2009;3:E29-E30.

[5] Wegner HE, Herbst H, Dieckmann KP. Paratesticular epidermoid cystand ipsilateral spermatic cord dermoid cyst: case report and discussionof 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 dermoidcyst 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 sublingualdermoid 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 cellcarcinoma arising in an epidermoid cyst: a case report and review ofliterature. Clin Neurol Neurosurg 2007;109:888-91.

2060 M. Prada-Arias et al.

Dermoid cyst of the spermatic cord in childrenClinical caseDiscussionReferences