testicular epidermoid cyst

Epidermoid

cyst testicle ultrasound

Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. Greyscale US image showing the intratesticular lesion of heterogeneous but predominantly low reflectivity. An onion-ring shape is created by some internal alternating hyper- and hypoechoic areas. Some mural calcifications are also noted (arrowhead).

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Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. Colour Doppler imaging showing no internal blood flow signals but a rim of increased peripheral vascularity (arrowheads).

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Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. Power Doppler imaging confirms the previous findings.

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Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. On colour-coded strain elastography, the lesion appears uniformly red, indicating hard tissue.

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Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. On quantitative map of elastography, the lesion shows increased shear wave velocities compared to testicular parenchyma.

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Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. On contrast-enhanced ultrasound 25 seconds after the administration of microbubbles, the lesion showed no internal enhancement.

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Multiparametric

Ultrasound Imaging of a testicular epidermoid cyst in a child. 45 seconds after the administration of microbubbles still no enhancement was visible within the lesion. A rim of peripheral enhancement is visualized (arrowheads).

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Radiopaedia • CC-by-nc-sa 3.0 • de

Testicular epidermoid cysts, also known as keratocysts, are rare benign tumors.

Epidemiology

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 .

Clinical presentation

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.

Pathology

Composed of layers of keratinous debris lined with keratinizing squamous epithelium.

Radiographic features

Ultrasound

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

MRI

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.