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Case of the Month

January 2007

Patient Data: 37 year old male

Clinical Info: Painless palpable mass


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Inhomogeneous cystic lesion in the right testicle


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Extended field of view image of the testis and the lesion.


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The lesion contains echogenic material that with some fantasy has a slight ring like structure.


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With color doppler there is only vascularity around the lesion but not within the lesion.


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Again the same findings with color doppler. Note that there is some acoustic shadowing. How would you interpret the findings? Is the lesion probably benign or malignant? Compare the images with the next two cases:


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Partly cystic lesion in the testis of a 49 year old male


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Color doppler image of the same patient shows some vascularity within the lesion.


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This is a lesion in the testis of a 35 year old patient with microlithiasis that is partly cystic with peripheral vascularity.

How would you interpret these lesions?

The first lesion proved to an epidermoid cyst during operation.
The classic sonographic description of an epidermoid cyst is a mass with a target or onion ring appearance. However this is often not the case. The lesion can be inhomogeneous with cystic elements. Histologically the tumor consists of cystic cavities lined by squamous epithelium and contains desquamated keratinized epithelium.


The second and third lesion both proved to be teratomas.
Only one of the teratomas showed some vascularity within the lesion. There is considerable overlap of the sonographic appearances of teratomas and epidermoid cysts of the testis, so in these cases the histological examination is crucial.

The treatment of these lesions is different The epidermoid cyst can be treated by local enucleation, and the teratoma requires radical orchiectomy.

See also

References
Dogra VS, Gottlieb RH, Rubens DJ, Liao L.
Benign intratesticular cystic lesions: US features.
Radiographics. 2001 Oct;21 Spec No:S273-81. Review

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