青春期前畸胎瘤-罕見的成人睪丸腫瘤案例報告

林奇柏、王百孚、石宏仁、林介山、張進寶、嚴孟意、黃勝賢、陳俊吉、江恆杰、張建祥、
陳柏華、陳一中、潘岳

彰化基督教醫院泌尿外科

Prepubertal teratoma, a rare cause of adult testicular tumor: a case report

Chi-Bo Lin, Pai-Fu Wang, Hung-Jen Shih, Jesun Lin, Chang-Pao Chang, Meng-Yi Yan, Sheng-Hsien Huang, Chun-Chi Chen, Herng-Jye Jiang, Jian-Xiang Zhang, Pao-Hwa Chen, Yi-Zhong Chen, Pan Yueh

Division of Urology, Department of Surgery, Changhua Christian Hospital

According to the 2016 WHO classification of tumors of the urinary system and male genital organs, prepubertal-type teratoma is a newly-defined subtype of germ cell tumor and is considered to be unrelated to germ cell neoplasia in situ (GCNIS) and distinct from postpubertal-type teratoma. Prepubertal teratoma is considered an indolent tumor. The testis shows normal spermatogenesis and has no metastatic potential. Prepubertal teratoma includes dermoid or epidermoid cysts. Testicular epidermoid cysts constitute only 1% of all testicular neoplasms. The typical sonographic characteristics of testis epidermoid cyst may showed onion-ring appearance with alternating hyperechoic and hypoechoic layers. The testicular epidermoid cyst commonly manifested as sharply demarcated bulls-eye intratesticular lesions in MRI image with increased signal intensity at the rim and no enhancement of the central area. Herein, we present a case with testicular prepubertal teratoma from clinical presentation, image, management, pathology and follow-up condition after nearly a year.

This is a case of a 22-year-old male patient with a palpable painless mass in the right-sided testis discovered during the circumcision operation. He denied any symptoms before. Scrotal ultrasound and magnetic resonance imaging revealed a 14.2 X 13.4 mm mass inside the right testis. Due to homogenous  intensity with mild contrast enhancement in MRI image, the seminoma was suspected. The serum tumor makers, including βhCG, AFP and LDH were within normal limits. Radical testicular resection was then conducted on 2022-5-18. The pathologic report proved the mass to be a testicular epidermoid cyst, a rare form of prepubertal-type teratoma. There was no germ cell neoplasia in situ is found under extensive sampling and immunostains of PLAP and D2-40. The patient was discharged uneventful after the operation. Currently, the patient is following up in our outpatient department.