Indian Journal of Urology
UROPATHOLOGY
Year
: 2006  |  Volume : 22  |  Issue : 3  |  Page : 275--276

Lymphangioma of epidydimis: An extremely rare cause of scrotal swelling


KK Pai1, D Roy2,  
1 Department of Pathology, Sikkim Manipal Institute of Medical Sciences, Tadong, Sikkim - 737 102, India
2 Department of Surgery, Sikkim Manipal Institute of Medical Sciences, Tadong, Sikkim - 737 102, India

Correspondence Address:
K K Pai
Dept of Pathology, Sikkim Manipal Institute of Medical Sciences, Tadong, Sikkim - 737 102
India

Abstract

Lymphangioma of epidydimis is a very rare cause of scrotal swelling. We report a case of lymphangioma of epidydimis in a 24 year old male. This case is being presented in view of its rarity.



How to cite this article:
Pai K K, Roy D. Lymphangioma of epidydimis: An extremely rare cause of scrotal swelling.Indian J Urol 2006;22:275-276


How to cite this URL:
Pai K K, Roy D. Lymphangioma of epidydimis: An extremely rare cause of scrotal swelling. Indian J Urol [serial online] 2006 [cited 2021 Jul 28 ];22:275-276
Available from: https://www.indianjurol.com/text.asp?2006/22/3/275/27643


Full Text

Lymphangioma of the epididymis is an extremely rare cause of scrotal swelling. Thompson reported the first case of lymphangioma of the epididymis in 1936.To date, only five cases have been reported in the English literature.[1],[2],[3],[4]

Lymphangiomas are thought to be congenital anomalies from the abnormal development of the lymphatic vessels, arising from sequestrations of lymphatic tissue that fail to communicate normally with the lymphatic system.[1],[5] They are composed of one or several cysts lined by a single layer of endothelium, which range from 0.1 to 5 cm in diameter. Lymphangiomas are commonly seen in the head and neck regions, especially in children. Lymphangioma of the epididymis is, however, exceedingly rare. Etiologically, lymphangiomas of the epididymis in an adult may arise as a true primary neoplasm or secondary to lymphatic obstruction associated with surgery or trauma.[3] One case of lymphangioma of the epididymis reported in the literature was thought to develop secondary to herniorrhaphy.[3]

Its importance lies in the differential diagnosis of testicular and paratesticular tumors. Its cystic nature, location and relationship to neighboring structures can be determined on ultrasound. But these characteristics are not pathognomonic to lymphangioma of the epididymis as these features are also seen with epidermal cysts. However, the differentiation has little practical value because they are both benign and require surgical excision when symptomatic. The treatment of lymphangioma of the epididymis is surgical excision. The procedure seems to be curative, as thus far no relapse has been reported in the literature.

We present a case of 24-year-old man with left-sided indirect inguinal hernia since six months. On clinical examination, a mass lesion separate from the hernial was felt at the upper pole of the epididymis. A clinical diagnosis of Indirect Inguinal hernia with epididymal cyst was made. No prior history of trauma or surgery was present. Peroperatively, a mass lesion arising from the epididymis was seen which was adherent to the hernial sac. The hernial sac and the mass lesion were excised.

The excised specimen, consisting of a soft spongy mass measuring 2.5 x 1.5 cm,with tiny cystic spaces, was found adherent to the hernial sac [Figure 1]. The sections revealed large irregularly shaped cystic spaces, which were lined by a single layer of endothelium, situated in a loose connective tissue stroma. The cystic spaces contained eosinophilic substance. There was also moderate lymphocytic infiltration of the stroma, forming lymphoid aggregates. The histological diagnosis was that of lymphangioma of the epididymis [Figure 2].

The occurrence of scrotal swelling in a young man is always a cause of concern; the clinical differential diagnoses include both benign and malignant conditions. In rare cases, one may be surprised with a diagnosis of lymphangioma of the epididymis.[6]

References

1Enzinger FM, Weiss SW. Tumors of lymph vessels. In : soft tissue tumors, 2nd ed. Mosby Co: St. Louis; 1988. p. 614.
2Edwards WD, Wold LE. Congenital lymphangiectasis. In : Coulson WF (editor). Surgical pathology. Philadelphia: Lippincott Co; 1988. p. 499.
3Postius J, Manzano C, Concepcion T, Castro D, Gutierrez P, Banares F. Epididymal lymphangioma. J Urol 2000;163:550-1.
4Kok KY, Telesinghe PU. Lymphangioma of the Epididymis. Singapore Med J 2002;43:249-50.
5Bill AH Jr, Sumner DS. A unified concept of lymphangioma and cystic hygroma. Surg Gynecol Obstet 1965;120:79-86.
6Thompson GJ. Tumors of the spermatic cord, epididymis and testicular tunics. Surg Gynecol Obstet 1936;62:712.