Intrascrotal Testicular and Extratesticular Epidermoid Cysts: About Two Cases

Abstract

Painless solid testicular masses on ultrasonography are commonly malignant. However, if the lesion is well demarcated, rounded, and hypoechoic with alternating hyperechoic and hypoechoic layers, and no internal vascular flow, the possibility of an epidermoid cyst should be considered. Epidermoid cysts are uncommon benign testicular lesions and are extremely rare in the intrascrotal extratesticular region. Including these cysts in the differential diagnosis may allow the urologist to perform testis-sparing surgery. Teaching Point: The possibility of an epidermoid cyst should be considered when a scrotal mass shows an 'onion ring' appearance on sonography and no vascularity on Doppler.

Keywords: epidermoid cyst; scrotum; testis.

Figure 1

(a) B-mode sonography of the left testis shows an intratesticular mass with concentric rings of alternating echogenicity with a more echogenic central core. (b) Color Doppler sonography shows the absence of a vascular signal within the mass and a more echogenic central core (arrowhead).

Figure 2

Ultrasonography of the right hemiscrotum shows a mild hydrocele and an extratesticular intrascrotal mass with concentric rings of alternating echogenicity. Note the hyperechogenic central core (arrowhead).