Question:

When diagnosing testicular epidermoid cysts, which of the following are correct?
1. MRI is necessary for diagnosis.
2. Benign and malignant testicular lesions are easily differentiated clinically.
3. Marked elevation of serum Ã'ƒÆ’Ã'…¸-human chorionic gonadotropin and ?- fetoprotein suggest the diagnosis.
4. Ultrasound can suggest the diagnosis pre-operatively.
5. Invasion of epididymis, spermatic cord, and/or scrotal skin is common.





Answer:

The correct answer for the question "When diagnosing testicular epidermoid cysts, which of the following are correct?" is:

4. Ultrasound can suggest the diagnosis pre-operatively.



Explanation
A. MRI is not typically necessary for diagnosis. Although several publications have described typical MRI characteristics, preoperative characterization is often possible with ultrasound alone, thus allowing for the possibility of testicular sparing surgery.  [Therefore, when preoperative ultrasound suggests an epidermoid cyst of typical size less than 3cm in a patient with negative tumor markers, testicular sparing surgery should be considered as an alternative to radical orchiectomy.]

B. Both benign and malignant lesions often present as painless testicular masses.  [They are clinically indistinct from other testicular lesions often presenting as painless masses.]

C.  Being benign lesions results of tumor marker studies are negative. [Epidermoid cysts are benign lesions accounting for approximately 1-2% of resected testicular masses.]

D.  Although not diagnostic, preoperative characterization is possible with ultrasound, thus allowing for the possibility of testicular sparing surgery.  "Therefore, when preoperative ultrasound suggests an epidermoid cyst of typical size less than 3cm in a patient with negative tumor markers, testicular sparing surgery should be considered as an alternative to radical orchiectomy."

E.  Epidermoid cysts are well circumscribed non-invasive lesions.  Any infiltration of these structures should suggest another diagnosis.  [Epidermoid cysts are benign lesions accounting for approximately 1-2% of resected testicular masses.]



From the manuscript:
Case report of a testicular epidermoid cyst and review of its typical sonographic features
Radiology Case. 2010 Sep; 4(9):18-23


This article belongs to the GU section.




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From the manuscript

Case report of a testicular epidermoid cyst and review of its typical sonographic features

Free full text article: Case report of a testicular epidermoid cyst and review of its typical sonographic features

Abstract
A case of testicular epidermoid cyst, demonstrating multiple characteristic sonographic patterns in a single lesion, is presented with a brief review of the distinctive ultrasound features. It is important to remember that the sonographic patterns describing testicular epidermoids represent the varied amounts and arrangements of keratin of a particular lesion. A given lesion may demonstrate subtle variability or more than one characteristic pattern at any given time. With this in mind, preoperative characterization of testicular epidermoids should allow for increasing utilization of testicular sparring surgery in the management of this benign lesion.






References



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