World J Mens Health.  2015 Aug;33(2):117-120. 10.5534/wjmh.2015.33.2.117.

The Testis Completely Replaced by a Huge Epidermal Cyst in an Older Man

• Park KK
• Hyun CL
• Kim SD
• Kim YJ
• Huh JS

• KMID: 2032832
• DOI: http://doi.org/10.5534/wjmh.2015.33.2.117

Abstract

Epidermal cysts are commonly encountered, slow-growing superficial cysts in the hair-bearing areas of the body, and are usually discovered in the second and fourth decades of life. These cysts tend to be superficial, meaning that they can be easily found by ultrasound and digital palpation at a moderate degree of growth. However, we found a huge testicular cyst that went undetected until old age. In this report, we describe the interesting case of a patient in whom the right testis was totally replaced with an epidermal cyst. The cyst was found by ultrasonography and further evaluated with magnetic resonance imaging. We performed orchiectomy under the impression of an epidermal cyst. The pathologic report confirmed this clinical impression. Over 24 months of follow-up, we did not find any recurrence of a growing mass on the testis.

Keyword

Aged, 80 and over; Epidermal cyst; Testicular neoplasms

MeSH Terms

Aged, 80 and over
Epidermal Cyst*
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Orchiectomy
Palpation
Recurrence
Testicular Neoplasms
Testis*
Ultrasonography

Figure

• 

  Fig. 1 Imaging findings of the right scrotum. (A) Scrotal ultrasonography showed a mixed echoic mass with a small spindle-shaped echogenic reflector and a filiform anechoic area within the parenchyma in the right testis. The mixed echoic mass had totally replaced the right testis. Posterior echoic enhancement was also seen. On Doppler imaging, increased flow was not found in the mass. (B) Magnetic resonance imaging showed a 9-cm, thin-walled, cystic oval component without internal enhancement, filling the entire right testis in the right scrotum.

• 

  Fig. 2 Gross findings of the right testicular cystic mass. The specimen was a large cyst (9.0×6.2×4.5 cm, 166 g), with a relatively smooth outer surface.

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  Fig. 3 Microscopic appearance of the epidermal cyst of the testis. Microscopically, the cyst was observed to be lined by flattened squamous epithelium (black arrows) showing keratinization, and the cyst was filled with laminated materials resembling keratin (red arrows) (A: H&E, ×100; B: H&E, ×200). The surrounding testicular tissues (yellow arrow) and the adnexal tissues of the testis were noted to be normal, and no evidence was found of intratubular germ cell neoplasia or other dermal adnexal structures or teratomatous elements.

Reference

1. Kirkham N. Tumors and cysts of the epidermis. In : Elder DE, Elder DE, editors. Lever's histopathology of the skin. 8th ed. Philadelphia: Lippincott-Raven;1997. p. 964–950.

2. Lee HS, Joo KB, Song HT, Kim YS, Park DW, Park CK, et al. Relationship between sonographic and pathologic findings in epidermal inclusion cysts. J Clin Ultrasound. 2001; 29:374–383.

3. Denison CM, Ward VL, Lester SC, DiPiro PJ, Smith DN, Meyer JE, et al. Epidermal inclusion cysts of the breast: three lesions with calcifications. Radiology. 1997; 204:493–496.

4. Maizlin ZV, Belenky A, Baniel J, Gottlieb P, Sandbank J, Strauss S. Epidermoid cyst and teratoma of the testis: sonographic and histologic similarities. J Ultrasound Med. 2005; 24:1403–1409. quiz 1410-1

5. Terada T. Squamous cell carcinoma originated from an epidermal cyst. Int J Clin Exp Pathol. 2012; 5:479–481.

6. Cho JH, Chang JC, Park BH, Lee JG, Son CH. Sonographic and MR imaging findings of testicular epidermoid cysts. AJR Am J Roentgenol. 2002; 178:743–748.

7. Huang CC, Ko SF, Huang HY, Ng SH, Lee TY, Lee YW, et al. Epidermal cysts in the superficial soft tissue: sonographic features with an emphasis on the pseudotestis pattern. J Ultrasound Med. 2011; 30:11–17.

8. Price EB Jr. Epidermoid cysts of the testis: a clinical and pathologic analysis of 69 cases from the testicular tumor registry. J Urol. 1969; 102:708–713.

9. Malvica RP. Epidermoid cyst of the testicle: an unusual sonographic finding. AJR Am J Roentgenol. 1993; 160:1047–1048.

10. Arellano CM, Kozakewich HP, Diamond D, Chow JS. Testicular epidermoid cysts in children: sonographic characteristics with pathological correlation. Pediatr Radiol. 2011; 41:683–689. quiz 796-7