Our patient presented with sudden onset

Our patient presented with sudden onset of scrotal enlargement and irritability. Although these symptoms were not usual manifestations of testicular torsion, they were compatible with those of a 3-month-old, since young infants may show obscure clinical features. A cystic testicular lesion is often mistaken for a hydrocele; however, a hydrocele usually has a thin wall and is seldom associated with undescended testis. In our patient, the mass had a thick wall and no testis was identified on sonography and MRI. These findings were not compatible with a hydrocele. Cystic lesions of the testis in children are rare, and some cystic testicular lesions should be considered including epidermoid cyst, dermoid cyst, cystic dysplasia of the rete testis, juvenile granulosa cell tumor, simple cyst and cystic degeneration in the early stages after torsion. Generally, a differential diagnosis can easily be made by pathological examination. The pathology of the mass in our patient revealed a few small tubules that were focally filled with small cuboidal cells, which were compatible with atrophic testicular tissues. Such pathological findings made the diagnoses of epidermoid cyst, dermoid cyst, cystic dysplasia of the rete testis and juvenile granulosa cell tumor unlikely. The rare simple testicular cyst is lined with a flat or cuboidal epithelium with a fibrous tissue wall, with no chronic parp inhibitors or fibrosis outside the cyst wall. The lesion in our patient had a fibrosis outer layer covering the inner layer of atrophic testicular tissue, which was inconsistent with a simple testicular cyst. In addition to this, the vas deferens and vessels of the spermatic cord were less prominent than usual and the spermatic cord was constricted at the junction between the mass and the cord. This was compatible with testicular torsion. By combining the clinical features, sonographic and MRI data, operative and pathological findings, the change in the testis was considered to be cystic degeneration after initial necrosis due to testicular torsion. Temporal change of the testis after prenatal testicular torsion has been observed in nine patients, all of whom showed progressive atrophy of the testis with decreased testicular size on the affected side. Histologically, the atrophic testicle, following a prolonged period since presentation, is composed of a necrotic center surrounded by a thickened, fibrotic tunica albuginea. In our patient, the outer layer of the cystic wall was a thickened fibrotic capsule, which was compatible with the long-term changes of the tunica albuginea after torsion. The atrophic testicular tissue remnants in the inner layer of cyst wall and the central cystic portion represented a cystic change after testicular necrosis. Such a picture of atrophic testis with a thick-walled cyst containing clear fluid has not previously been reported in the literature as a late presentation of testicular torsion. This rare presentation should be kept in mind during the differential diagnosis of a scrotal mass. The pathogenesis of this rare event is unknown and requires further investigation. Testicular torsion should be considered in a 3-month-old boy presenting with sudden scrotal enlargement and irritability, and sonography will help make an appropriate differential diagnosis from hydrocele. Immediate surgical intervention and derotation may salvage the affected testis. There is currently no definitive evidence of the benefit of continued observation or orchiectomy for delayed presentation of cases. We advocate that healthcare practitioners follow the principle of management for perinatal testicular torsion involving derotation of the testis and leaving it in place, especially in infants. This is because there is the chance of some tissue surviving after torsion, especially the Leydig cells, just as the histology of the specimen showed in this case.
Introduction Calcifying fibrous tumor (CFT) is an uncommon and benign tumor which was first described by Rosenthal and Abdul-Karim in 1988. Most CFT cases have been reported in children and young adults.