Benign scrotal masses in children – some new lessons learned

IntroductionA preponderance of benign intratesticular masses in pre-pubertal males encourages testicular-sparing surgery (TSS).ObjectiveTo review outcome of benign testicular lumps in children managed at a tertiary pediatric center more than 7.5 years.MethodsA retrospective review of pediatric benign testicular lesions from January 2008 to June 2015 was performed.ResultsThere were twelve benign intratesticular tumors. Of these, 11 were in pre-pubertal males; comprising four teratomas, two epidermoid cysts, one dermoid cyst, two cases of Leydig cell hyperplasia, one cystic dysplasia of the rete testis and one large simple intratesticular cyst. We illustrate a case of Leydig cell hyperplasia presenting with precocious puberty limited to the ipsilateral hemi-scrotum. TSS was attempted in all 11 pre-pubertal cases, but successfully performed in seven. TSS was possible for a large testicular cyst seemingly replacing the entire testis, with evidence that the testis reconstituted itself after surgery. Recurrence of an epidermoid cysts reported.ConclusionFor the first time in the literature, this series reports Leydig cell hyperplasia presenting with ipsilateral hemi-scrotal changes of precocious puberty; shows evidence that the testis reconstitutes itself after TSS for a large cyst; and reports recurrence of an epidermoid cyst after TSS.