精索附睾间皮囊肿的诊治（附11例报告并文献复习）

Diagnosis and treatment of mesothelial cyst of spermatic cord and epididymis：a report of 11 cases and literatures review

目的 提高对精索、附睾问皮囊肿的诊断、鉴别诊断及治疗的认识.方法 回顾总结11例精索、附睾间皮囊肿病例,观察和分析其临床和病理组织学特点.结果 患者平均年龄59.55岁,精索囊肿4例,其中左侧2例,右侧2例;附睾囊肿7例,其中右侧5例,左侧1例,双侧多发囊肿1例.囊肿直径1～8cm,术前B超诊断精索囊肿5例,附睾囊肿5例,睾丸鞘膜积液l例.11例患者均行手术,1例双侧附睾切除,2例单侧附睾切除,其余完整切除囊肿.术中发现精索间皮囊肿多位于内外环间或偏于外环口处;附睾间皮囊肿多发于附睾头,多发囊肿布满附睾体部.病理结果：间皮囊肿伴间皮增生.免疫组化结果：CK[＋],Vim[＋],Calretinin[＋],CK5/6[＋],WT.1[＋],D2-40[＋].术后随访1～3.5年,均未见囊肿复发.结论 精索、附睾间皮囊肿是少见的良性病变,病史、体检及病理检查对本病的诊断有决定意义,主张采用彻底囊肿剜除或附睾切除术.

Objective To improve the diagnosis and treatment of the mesothelial cyst of spermatic cord and epididymis. Methods Clinical and pathological features of 11 cases of mesothelial cyst of spermatic cord and epididymis were reviewed and summarized retrospectively. Results The average age of patients was 59.55 years old. 11 cases of mesothelial cyst including 4 cases spermatic cord cyst（2 cases in the left and 2 in the right） and 7 cases epididymis cyst（1 case in left, 5 cases in the right and 1 case bilateral multiple cysts ）. Cyst diameter ranged from lcm to gem. 5 cases spermatic cord cyst, 5 cases epididymal cyst and 1 case hydrocele were all diagnosed by preoperative B-ultrasonography. Eleven cases underwent surgery including 1 case of bilateral epididymal excision, 2 cases of uni- lateral epididymis excision, others of complete cyst excision. Spermatic cord mesothelial cyst mainly located at in- guinal canal near the superficial inguinal ring; epididymis mesothelial cysts located mainly at the epididymal head. Multiple cysts were at epididymal body. Pathology results showed that all were mesothelial cyst with mesothelial hyperplasia. Immunohistochemistry analysis showed that it had CK [＋], Vim [＋], Calretinin [＋], CK5 / 6 [＋], WT-1 [＋], D2-40 [＋].No cyst recurrence was found in the treated patients during 1 to 3.5 years following-up, Conclusion Mesotheliai cysts of spermatic cord and epididymis were all rare benign testicular lesions. Diognosis of this disease mainly depended on histopathological analysis. Conservative treatment was recommmeded in the cyst resection.