International Surgery Journal | August 2019 | Vol 6 | Issue 8 Page 1 International Surgery Journal Rengan V et al. Int Surg J. 2019 Aug;6(8):xxx-xxx http://www.ijsurgery.com pISSN 2349-3305 | eISSN 2349-2902 Case Report Multiple scrotal epidermoid cysts: a case of cosmetic infertility Vinayak Rengan, Vinodh Duraisami*, Chetna Ravindra, Karthick Muralidharan INTRODUCTION Sebaceous cyst is a small, dome-shaped cyst that develops in the skin, filled with a thick, greasy, cheese- like substance. Sebaceous cysts are very common and can occur in any area of hair-bearing skin, but mostly on the scalp. They are also found on the face, neck, back, and scrotum. 1 The cyst looks like a hemisphere on the skin. It is whitish or skin-colored. Cysts usually vary in size from 1cm to 4cm in diameter. They occur singly or in groups. The cysts are usually painless but may become red and painful if infected. Etiology is unclear but duct obstruction of a sebaceous gland in the hair follicle can result into the accumulation of the sebum leading to the development of retention cyst. 2 Other causes include a developmental defect of the sebaceous duct or traumatic implantation of surface epithelium beneath the skin. They can develop at any age but are usually first noticed in adult life. 3 The typical outpatient surgical procedure for cyst removal is to numb the area around the cyst with a local anesthetic, then to use a scalpel to open the lesion with either a single cut down the center of the swelling or an oval cut on both sides of the center point. 4 If the cyst is small, it may be lanced instead. The person performing the surgery will squeeze out the contents of the cyst, then use blunt-headed scissors or another instrument to hold the incision wide open while using fingers or forceps to try to remove the cyst wall intact. If the cyst wall can be removed in one piece, the "cure rate" is 100%. 5 CASE REPOERT A 48 years old man presented to the surgical outpatient department with complaints of infertility after 20 years of marriage. On further questioning, he gave a history of multiple painless swellings on his scrotum for the past 20 years (Figure 1A). He had undergone an incomplete surgery with a practitioner of native medicine which resulted in recurrence. He had avoided all sexual relations with his wife due to potential embarrassment. On examination, the patient had multiple firms, non-tender swellings in the scrotum. Differential diagnosis of either scrotal sebaceous cysts or calcinosis cutis was made. Ultrasound of the scrotum showed that both tests were normal. Semen analysis was done and the results came back normal. Serum calcium, phosphate, and alkaline ABSTRACT A 48 years old man presented to the surgical OPD with a history of multiple painless swellings on his scrotum for 20 years. He had avoided all sexual relations with his wife due to potential embarrassment. A clinical diagnosis of scrotal epidermoid cysts was made. Both testes were normal on ultrasound. Upon surgery, the scrotal skin was thoroughly excised, and primary closure of skin was done. Postoperative period was uneventful. The patient engaged in intercourse with his partner two weeks after surgery. The man and his partner were referred to the psychiatry unit for appropriate counselling. Scrotal epidermoid cysts cause significant psychological handicap. In Asian countries, the taboo of seeking medical assistance for genital conditions still exists. The treatment of scrotal epidermoid cysts requires a team of surgeons, psychologists, and psychiatrists. Keywords: Genitourinary tract, Painless swellings over the scrotum, Scrotal epidermoid cysts Department of General Surgery, Institute of General Surgery, Madras Medical College, Chennai, Tamil Nadu, India Received: 16 June 2019 Accepted: 02 July 2019 *Correspondence: Dr. Vinodh Duraisami, E-mail: arvindr84@gmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. DOI: http://dx.doi.org/10.18203/2349-2902.isj20193116