Intratesticular epidermoid cyst

Case contributed by Callum Smith


Painless lump in right testis

Patient Data

Age: 30 years
Gender: Male

There is a well circumscribed intratesticular mass at the upper pole of the right testis. The mass contains alternating hyperechoic and hypoechoic rings, demonstrating a lamellar ("onion skin") appearance. There is no vascularity within the testicular lesion. The surrounding testis is normal. These findings are suggestive of an intratesticular epidermoid cyst. 

Macroscopic photograph of hemisected right testis


Photograph of a hemisection of the right testis which demonstrates a well circumscribed spherical nodule in the superior pole. The nodule has a diameter of 21 mm and abuts but does not extend into the tunica albuginea. The surface of the nodule is tan with concentric lamellation. The rest of the testicular tissues are grossly unremarkable. 

Microscopic section of right testis


This section shows masses of lamellated keratin in the lumen associated with a thin peripheral lining of keratinized squamous epithelium. No other elements are seen. The testicular tubules adjacent to this exhibits pressure atrophy. The rest of the testicular tubules appear normal and there is no evidence of intratesticular neoplasia. These findings are consistent with an epidermoid cyst of the testis.

Case Discussion

A 30-year-old man presented with a painless right testicular lump. Tumor markers were normal. He subsequently underwent orchiectomy. The diagnosis of an intratesticular epidermoid cyst was confirmed histologically.

Intratesticular epidermoid cysts are rare benign testicular tumors which account for 1% of testicular tumors. The typical appearance on ultrasound is a well circumscribed mass with a lamellar or "onion skin" appearance. The management of intratesticular epidermoid cysts is controversial. Previously radical orchiectomy was the gold standard, however, there is emerging evidence to suggest that the typical radiological appearance on ultrasound combined with negative tumor markers and a biopsy negative for intraepithelial neoplasia is sufficient to make the diagnosis. The patient may then undergo testis-sparing surgery 1-3

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