Epidermoid cyst discovered concomitant with torsion of the spermatic cord: A case report

Abstract

Testicular epidermoid cysts, accounting for 1%-2% of all testicular masses, present a diagnostic challenge often identified post-orchiectomy. Conservative surgery is recommended, emphasizing the need for accurate preoperative diagnosis. A 28-year-old patient with acute left scrotal pain, initially suggestive of testicular torsion, underwent intraoperative exploration revealing extra-vaginal torsion with an incidentally discovered 2-cm intra-testicular mass. Due to suspected malignancy, a total orchiectomy was performed. Pathological analysis confirmed an epidermoid cyst with normal postoperative tumor markers. The patient had a good postoperative outcome and underwent testicular prosthesis placement 3 months after the surgery. Epidermoid cysts, often identified incidentally during urgent scenarios, underscore the importance of accurate preoperative diagnosis. Conservative surgery remains the preferred approach, emphasizing the consideration of benign factors to prevent unnecessary orchiectomies.

Keywords: Epidermoid cyst; spermatic cord torsion; testicle; testis sparing surgery.

Figure 1.

Inferior polar intra-testicular mass adjacent to the left testicle.

Figure 2.

Pathological appearance favors an epidermoid cyst of the testis. (a) Cystic formation bordered by stratified and keratinized squamous epithelium, containing lamellae of orthokeratotic keratin. (b) Squamous lining with preserved architecture. (c) Small fibrous connective tissue resting on testicular parenchyma made up of testicular tubules without atrophy.