Sonographic appearance of a calcified simple epidermoid cyst of the testis

Abstract

Simple epidermoid cysts of the testis are rare, benign lesions. The reported sonographic findings are varied, but to date there has been no report of an epidermoid cyst presenting as an echogenic mass with dense acoustic shadowing. We report such a case. CASE REPORTA 52-year-old white man with prostatitis experienced vague, intermittent, right testicular pain. He had no prior trauma, swelling, redness, or weight loss. Physical examination revealed a discrete, rock-hard, nontender right testicular mass. The left testis was normal. No adenopathy was palpated. Real-time ultrasonography of the scrota1 contents using a 7.5-MHz transducer (Siemens Sonoline SE Erlangen, West Germany) revealed a well-circumscribed, 1.5-cm lesion within the parenchyma of the right testis. The mass had a highly echogenic margin with dense acoustic shadowing, characteristic of calcification ( Figure 1A). The right testis was not enlarged and was otherwise normal in texture. The left testis and both epididymides were normal. A radical right orchiectomy was performed for possible carcinoma.A nodular cystic mass measuring 1.5 cm in diameter was seen on cut section. The cyst contained yellowish, tan, cheese-like material, and had a calcific, fibrotic wall ( Figure 1B). Microscopic evaluation demonstrated a discrete cyst composed of collagenized fibrous tissue. No squamous epithelial lining was present, although the cyst contained squamous epithelial debris, heavy calcification, and ossification. No

Epidermoid Cysts of the Testes in Taiwanese Men

“…The standard treatment of intratesticular mass suspicious for cancer is inguinal radical orchiectomy; however, this treatment is unnecessary for patients with benign lesions. By using high-resolution ultrasonography and magnetic resonance imaging (MRI), the diagnosis of testicular epidermoid cyst can be confirmed before the operation [1,10,11], and the testis can be preserved by organ-preserving surgery.…”

Features of Testicular Epidermoid Cysts on Contrast-Enhanced Sonography and Real-time Tissue Elastography

“…Type 1 lesions have the classic “onion ring” appearance of well‐defined masses with concentric rings of hypoechogenicity and hyperechogenicity 5 . Type 2 lesions are densely calcified and appear as echogenic masses with a dense acoustic shadow 6 . Type 3 lesions are cysts with rim, peripheral, or central calcification, which gives a “target” pattern of a hypoechoic rim with an echogenic central portion, 7 or appear as hypoechoic masses with peripheral echogenicity due to mural calcification 8 .…”

Epidermoid Cyst of the Testis

“…6,19 Findings suggestive of an epidermoid cyst include a circumscribed, hypoechoic lesion with intralesional debris (sometimes resulting in mixed echogenicity because of hyperechoic areas due to keratin and hypoechoic areas due to cysts and nonkeratinized areas 5 ) and a hyperechoic margin. 16,20,21 The important differential diagnoses of epidermoid cyst are mature teratoma and dermoid cyst 9 and, as clinical means are of limited utility in separating the large number of potentially malignant testicular lesions from the less common, benign epidermoid cysts, pathologic observation is extremely important ( Table 1). This distinction is important as the malignant lesions may require additional treatment, including retroperitoneal lymph node dissection and chemotherapy, while epidermoid cysts do not.…”