細菌感染を合併し自壊した陰嚢類表皮嚢胞の1例

Abstract

63歳男.主訴は陰嚢部疼痛であった.抗生剤投与と消炎鎮痛剤によっても症状の軽快を認めず入院精査となった.右陰嚢の腫瘤は1年前に気付き, 徐徐に増大したとのことであった.右陰嚢は腫張し, 腫瘤は小鶏卵大で膿瘍を疑わせた.CTでは右精巣とは別に, 腫大した右陰嚢内容を認め, 陰嚢内膿瘍と診断し, 摘除術を予定したが, 前日に膿瘍は自壊した.摘除術を施行したところ皮下より膿と壊死組織の流出を認め, 掻爬した.陰嚢内部に膿瘍の隔壁を思わせる膜状組織を見出し, これを切除した.精巣は病巣とは連続しておらず温存可能であった.病理では陰嚢類表皮嚢胞と診断した.術後1年経過した現在, 再発は認められない

A 63-year-old male visited our hospital with the chief complaint of right scrotal pain. The right scrotum was swollen to the size of a small egg, and its skin was reddish. The mass was palpable independent of the right testis and epididymis. We diagnosed an intrascrotal abscess. The pus spontaneously issued from the scrotal mass. Sequentially, the abscess was extracted under spinal anesthesia. Membrane-like tissue assumed as the abscess wall was removed. Histologically, the abscess wall was composed of epidermal structure with epidermal keratinization, and horny material was found inside the wall. In the scrotal epidermis overlying the abscess, infiltration of neutrophils, lymphocytes, and multinucleated giant cells were observed. Anaerobic bacteria were detected in the pus of the abscess. Consequently, we diagnosed this case as rupture of an intrascrotal epidermoid cyst complicated by bacterial infection.