Case of the Week: Testicular Epidermoid Cyst (Ultrasound)

In this radiology lecture, we discuss the ultrasound appearance of testicular epidermoid cyst.

Key points include:

Testicular epidermoid cyst is a rare, benign, intratesticular neoplasm.
Most common in 2nd-4th decades, typically presents as a painless mass.
Lamellated, onion-like, bull’s-eye appearance: Alternating hyperechoic and hypoechoic concentric rings.
Appearance secondary to cyst filled with layers of keratin and lined with keratinizing squamous epithelium.
Non-vascular and sharply marginated.
Nonenhancing on MRI.
Important to recognize preoperatively because may be treated with conservative surgery.
Management somewhat controversial as originally diagnosed with orchiectomy.
Increasingly treated with enucleation if frozen sections of mass are consistent and tumor markers are negative.

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