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January 2007

Inhomogeneous cystic lesion in the right testicle
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Clinical information

Painless palpable mass

Ultrasound Images & Clips

37 year old male, Painless palpable mass

Inhomogeneous cystic lesion in the right testicle
Inhomogeneous cystic lesion in the right testicle
Extended field of view image of the testis and the lesion.
Extended field of view image of the testis and the lesion.
The lesion contains echogenic material that with some fantasy has a slight ring like structure.
The lesion contains echogenic material that with some fantasy has a slight ring like structure.
With color doppler there is only vascularity around the lesion but not within the lesion.
With color doppler there is only vascularity around the lesion but not within the lesion.
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:
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:
Partly cystic lesion in the testis of a 49 year old male
Partly cystic lesion in the testis of a 49 year old male
Color doppler image of the same patient shows some vascularity within the lesion.
Color doppler image of the same patient shows some vascularity within the lesion.
This is a lesion in the testis of a 35 year old patient with microlithiasis that is partly cystic with peripheral vascularity.
This is a lesion in the testis of a 35 year old patient with microlithiasis that is partly cystic with peripheral vascularity.

Conclusion

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.

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

Details

  • Sex: Male
  • Age: 37

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photo Taco Geertsma
Author

Dr. Taco Geertsma

Retired Radiologist, Gelderse Vallei Hospital

Dr. Taco Geertsma is the founder of UltrasoundCases.info and a retired radiologist and has worked in the Gelderse Vallei hospital from January 1, 1983. till July 1, 2014. He was the head of the ultrasound department for many years.

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