testicular epidermoid cyst
Testicular epidermoid cysts, also known as keratocysts, are rare benign tumors.
Testicular epidermoid cysts account for around 1-2% of all testicular masses and typically present in mid-adulthood (2 to 4decades) . They are the most common type of benign testicular neoplasms .
The presentation can be similar to those of malignant germ cell tumors. Patients typically present with a painless and non-tender, testicular mass between 1-3 cm in diameter.
Composed of layers of keratinous debris lined with keratinizing squamous epithelium.
- non-vascular, well-marginated intratesticular mass
- may demonstrate a characteristic lamellated "onion skin" or "whorled" appearance with alternating hyperechoic and hypoechoic rings
- some lesions may show a target appearance with a halo of hypoechogenicity and a central hyperechoic region
Tend to be well demarcated.
- T1: overall signal can be variable; may show alternating rings of high and low signal
- T2: may a low-intensity rim ; may also show alternating rings of high and low signal
- T1 C+ (Gd): typically no contrast enhancement
Treatment and prognosis
These lesions are benign with no malignant potential .
If the diagnosis of an epidermoid is suspected at the preoperative ultrasound, the lesion can be enucleated and frozen sections obtained to confirm the diagnosis. However, treatment is controversial; some authorities advocate orchiectomy, others suggest organ-sparing surgery.