testicular epidermoid cyst

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.

Differential diagnosis