Epidermoid cyst: An unusual presentation of a testicular mass.

Abstract

A 24-year-oldman presented to the clinic for a painless right testicular mass on examination. α-Fetoprotein, β-human chorionic gonadotropin, and lactate dehydrogenase tumormarkers werewithin normal limits. Scrotal ultrasonography depicted a well-demarcated intratesticular mass measuring approximately 1 cmwith alternating hyperechoic and hypoechoic rings (Fig. 1). Given that ultrasonographic features were concerning for a testicular epidermoid cyst, the decision was made to undergo inguinal partial orchiectomy. Partial orchiectomy was performed with the aid of intraoperative ultrasonography to confirm the location of the mass (Fig. 2). Frozen sections were obtained and were negative. Histological examination confirmed the diagnosis of epidermoid cyst (Fig. 3). The testicle was reconstructed, and the tunica vaginalis was closed with a running mattress suture. The patient was discharged home on the same day, and his postoperative course was uncomplicated. Surveillance ultrasonography of the scrotum at 20-month follow-up was negative for recurrence. Epidermoid cysts of the testicle are rare lesions and account for 1% to 2% of all testicular masses. First described by Dockerty and Priestly in 1942, they can either present as a benign subtype or in association with invasive germ cell tumors. They have many characteristics that are common with testicular cancer, because both are painless masses in men between the second and fourth decades of life. Ultrasonography characteristically shows a well-defined mass with alternating layers of keratin and squamous cells, manifesting as hyperechogenic and hypoechogenic rings in the form of an “onion skin.” Testis-sparing surgery is the preferredmanagement for masses less than 2 cm; thus, a partial orchiectomy was performed.