Dieckmann K P, Loy V
Urologische Klinik, Freien Universität Berlin, Germany.
Br J Urol. 1994 Apr;73(4):436-41. doi: 10.1111/j.1464-410x.1994.tb07611.x.
To review the records of patients with epidermoid cysts and those with germ cell tumours to determine the most appropriate method of treatment.
The records of the patients treated for epidermoid cysts and testicular germ-cell tumours in a period covering 22 years were analysed retrospectively. Nine specimens with an epidermoid cyst were examined by immunohistology for the presence of testicular intraepithelial neoplasia (TIN) (or carcinoma in situ of the testis).
Ten patients with a simple epidermoid cyst and 481 patients with testicular germ-cell tumour were treated during the observation period. The relative incidence of epidermoid cysts in relation to the number of patients with testicular germ-cell tumours was 2.1% (95% confidence interval 0.8-3.35%). The mean age of the 10 patients with an epidermoid cyst was 24.1 years. The right testis was affected in seven patients and the left in three. Six of these patients received conservative surgery with excellent cosmetic results. No relapse had occurred after a median observation period of 30 months. Immunohistological staining for placental alkaline phosphatase disclosed the absence of TIN in the parenchyma surrounding the cysts.
The absence of TIN calls into question the common assumption that an epidermoid cyst constitutes a monodermal teratoma. Two distinct entities of epidermoid cyst are proposed--one occurring in conjunction with a teratoma or a germ cell tumour (a 'complex' or 'mixed' epidermoid cyst) and the other a 'simple' epidermoid cyst without TIN in the adjacent tissue and thus representing a benign neoplasm that is not a teratoma. The absence of TIN near a simple epidermoid cyst justifies testis-sparing surgery.
回顾表皮样囊肿患者和生殖细胞肿瘤患者的病历，以确定最合适的治疗方法。
回顾性分析22年间接受表皮样囊肿和睾丸生殖细胞肿瘤治疗的患者病历。对9例表皮样囊肿标本进行免疫组织学检查，以检测睾丸上皮内瘤变（TIN）（或睾丸原位癌）的存在情况。
在观察期内，治疗了10例单纯表皮样囊肿患者和481例睾丸生殖细胞肿瘤患者。表皮样囊肿相对于睾丸生殖细胞肿瘤患者数量的相对发生率为2.1%（95%置信区间0.8 - 3.35%）。10例表皮样囊肿患者的平均年龄为24.1岁。右侧睾丸受累7例，左侧受累3例。其中6例患者接受了保守手术，美容效果良好。中位观察期30个月后未发生复发。胎盘碱性磷酸酶免疫组织化学染色显示囊肿周围实质中不存在TIN。
TIN的缺失对表皮样囊肿构成单胚层畸胎瘤这一普遍假设提出了质疑。提出表皮样囊肿有两种不同类型——一种与畸胎瘤或生殖细胞肿瘤同时出现（“复杂”或“混合”表皮样囊肿），另一种是“单纯”表皮样囊肿，其相邻组织中无TIN，因此代表一种非畸胎瘤的良性肿瘤。单纯表皮样囊肿附近无TIN证明保留睾丸手术是合理的。
