Epidermal Cyst in the Scrotum Successfully Treated while Preserving the Testis: A Case Report

Testicular epidermoid cyst: A rare entity - Case report

INTRODUCTION AND IMPORTANCE

Epidermoid cysts (ECs) of the testicle are rare benign lesions that can mimic more serious testicular masses. Accurate diagnosis is essential for proper management, often requiring surgical intervention to confirm the nature of the mass.

CASE PRESENTATION

A 21-year-old male presented with chronic pain in his right scrotum. Physical examination revealed a firm mass within the right testis. Ultrasound and MRI findings were consistent with an intratesticular EC. The patient underwent partial orchidectomy for further evaluation and treatment.

CLINICAL DISCUSSION

Histopathological analysis confirmed the diagnosis of an epidermoid cyst, characterized by a well-defined lesion with keratin-filled cystic spaces. The differential diagnosis for testicular masses includes both benign and malignant conditions. Imaging alone may not be sufficient to distinguish between these possibilities, making surgical exploration and histopathological examination necessary for definitive diagnosis.

CONCLUSION

This case highlights the importance of considering epidermoid cysts in the differential diagnosis of testicular masses in young males. Surgical intervention, such as partial orchidectomy, not only provides a definitive diagnosis but also serves as a therapeutic measure. The patient had an uneventful postoperative recovery, emphasizing the efficacy and safety of the surgical approach in such cases.

Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis

The commonly taught tenet that intratesticular lesions are always malignant and extratesticular scrotal lesions are always benign is a simplistic statement that erroneously minimizes the significance of extratesticular scrotal masses and their diagnosis. Yet, disease in the extratesticular space is commonly encountered by clinicians and radiologists and is often a source of uncertainty in diagnosis and management. Given the embryologically rooted complex anatomy of this region, a wide range of pathologic conditions is possible. Radiologists may not be familiar with some of these conditions; further, many of these lesions can have a specific sonographic appearance, allowing accurate diagnosis that can minimize surgical intervention. Lastly, malignancies can occur in the extratesticular space-although this is less common than in the testicles-and proper recognition of findings that warrant additional imaging or surgery is critical in optimizing outcomes. The authors present a compartmental anatomic framework for differential diagnosis of extratesticular scrotal masses and provide a comprehensive illustrative display of many of the pathologic conditions that can be encountered to familiarize radiologists with the sonographic appearances of these lesions. They also review management of these lesions and scenarios where US may not be definitive in diagnosis and selective use of scrotal MRI can be helpful. ^© RSNA, 2023 Quiz questions for this article are available in the supplemental material.