CONSERVATIVE MANAGEMENT OF CYSTIC DYSPLASIA OF THE TESTIS

Abstract

Cystic dysplasia of the testis is an unusual lesion in boys that has been historically treated with radical orchiectomy. This benign testicular neoplasm, which is often associated with ipsilateral renal agenesis or dysplasia, has been treated successfully with testis sparing surgery in the past.1, 2 To our knowledge the optimal treatment of this benign neoplasm has not been determined. We present 2 unique conservative methods of managing cystic dysplasia of the testis. CASE REPORTS Case 1. A5 1 ⁄2-year-old boy presented with left testicular swelling and pain. Scrotal sonography demonstrated an enlarged testis with multiple cysts of various sizes in the central portion with an associated hydrocele (see figure). Renal sonography showed an absent left kidney. The patient underwent left inguinal exploration, enucleation of the testicular mass and hydrocelectomy. Histological examination of the testicular specimen revealed dilated, irregular cavernous spaces lined by cuboidal epithelium, consistent with cystic dysplasia. Testicular biopsy demonstrated completely normal histology and a normal total germ cell count. A nontender enlarged left testis was noted again 4 months postoperatively. Testicular sonography revealed multiple cysts with a compressed rim of normal parenchyma. The patient underwent repeat scrotal exploration. A testis sparing approach with excision of the testicular mass was again performed. Histological examination revealed cystic dysplasia of the testis as well as normal testicular tubules containing germ cells. Tamm-Horsfall protein was also noted in the specimen. Serial testicular ultrasound has shown no evidence of a further recurrence of cystic dysplasia and almost equal testicular size during 14 months of followup. Case 2. A 9-year-old boy with a history of the VATER syndrome and a left multicystic dysplastic kidney presented with an enlarged left testis. At exploration during surgery for fecal incontinence the posterior portion of the testis appeared cystic and the testis was 2.4 3 1.5 3 1.9 cm. using calipers. Due to the close proximity of adherent epididymis the tissue was not resected. Scrotal sonography 8 months postoperatively revealed a large left testis with multiple multiloculated cystic structures less than 1 cm. in diameter in the mid portion of the testis, consistent with cystic dysplasia. A small rim of normal parenchyma surrounded the cystic structures. On ultrasound the left and right testes were 3.21 3 1.79 3 1.77 and 1.45 3 1.26 3 1.00 cm., respectively. On scrotal sonography 17 months later the left and right testes had enlarged to 3.6 3 2.3 3 1.5 and 1.8 3 1.5 3 1.0 cm., respectively. In the left testis a new 5 mm. cystic lesion was observed along the lateral aspect that had not been previously seen. DISCUSSION