Figure 1
Mass in the right testis
Clinical History
The patient presented a lump felt in the right testis for 3 months and a history of trauma.
Imaging Findings
The patient presented a lump felt in the right testis for 3 months and a history of trauma. Sonography was performed and showed a well-defined solid lesion in the testis with an echogenic rim and acoustic shadowing. The initial diagnosis was of a calcified haematoma.
A repeat scan was performed, which showed no change in the appearances. A diagnosis of epidermoid cyst was made. The patient was taken to surgery, where a simple operation of enulceation was performed. It was proven to be an epidermoid cyst on histology.
Discussion
Epidermoid cysts (also know as keratocysts) of the testes are benign uncommon tumours, accounting for 1% of all testicular tumours. They are small and non-tender and usually palpable. The usual age of presentation is 20-40 years. Histologically, these cysts comprise layers of keratin, within a fibrous capsule lined with simple squamous epithelium.
The ultrasound appearance varies depending on the quantity of keratin present within the mass. A solid mass with an echogenic rim is the usual feature, with peripheral acoustic shadowing. An "onion-ring" pattern of the periphery is described. They tend to have a target appearance. Four types of sonographic appearances have been described. The cysts do not show any blood flow on Doppler interrogation. They range in size from 1cm to 3cm. The right testis is supposedly more often involved than the left. These are benign tumours with no reported metastasis or local recurrence.
The lesion can easily be enucleated avoiding the necessity of an orchidectomy. Calcified haematoma, intratesticular cyst (anechoic centre and through transmission) or tetratoma are the differential diagnoses of these lesions.
Differential Diagnosis List
Epidermoid cyst of the testis
Final Diagnosis
Epidermoid cyst of the testis
References
[1]
Dogra VS, Gottlieb RH, Rubens DJ.
Benign intratesticularcystic lesions: US features.
Radiographics 2001 Oct;21:S273-81. (PMID: 11598263)
[2]
Pollack HM (ed)
Clinical Urography. Tumors of the testis and testicular adnexa. WB Saunders Company, Phildelphia pp 1732-3 (2000).
[3] Atchley JTM, Dewbury KC. Ultrasound appearances of testicular epidermoid cysts. Clinical Radiology 2000 Jul;55(7):493-502. (PMID: 10924372)
Case information
| URL: | https://eurorad.org/case/1864 |
| DOI: | 10.1594/EURORAD/CASE.1864 |
| ISSN: | 1563-4086 |
