br Case report A year old man who

Case report A 23-year-old man, who denied any systemic disease, history of recent trauma, or history of urinary tract infection, noted a right testicular mass for more than 5 years. A physical examination showed a hard mass, measuring 2 cm × 3 cm, without pain and with a tender sensation. All laboratory investigations, including tumor markers (AFP, beta-HCG, and LDH) were normal. A scrotal ultrasound with Doppler was performed, which revealed a 2–3 cm well-circumscribed heterogenic intratesticular mass with an echogenic rim (Fig. 1). No blood flow to the mass was detected by the Doppler ultrasound imaging (Fig. 1). The patient underwent enucleation of the mass through a right inguinal incision. An intraoperative frozen section was interpreted, and the regular pathological examination showed an epidermoid cyst and no evidence of malignancy. Enucleation of the lesion was then performed. The final pathology report stated that adenosine triphosphate the mass was an epidermoid cyst without teratomatous elements (Fig. 2). No recurrence of the tumor was noted after a 1-year follow-up.
Discussion Testicular cancer is relatively uncommon, with only approximately 5500 new cases being reported per year in the United States. Extratesticular tumors are more common than intratesticular tumors, and more than 95% of intratesticular rumors are malignant. Although benign intratesticular tumors are rare, its diagnosis is important to avoid unnecessary surgical intervention. Since Dockerty and Priestley first described epidermoid cysts of the testis in 1942, approximately 300 cases have been reported in the literature. Testicular epidermoid cysts are benign keratin-containing tumors, comprising up to 14%of childhood testicular neoplasms and 2%of adult testicular neoplasms. They occur in any age group from young children to the elderly, but are most common in people between the ages of 10 and 40 years. A firm, nontender, testicular mass is palpable in most cases. Serum levels of germ cell tumor markers are normal. The keratinized epithelium interspersed with connective tissue may provide this lesion with the classic “onion peel” configuration on an ultrasound. Epidermoid cysts range from 1 to 3 cm in diameter. Ultrasound findings of epidermoid cysts include a well-circumscribed heterogeneous mass with an echogenic rim (keratin deposition), and the color Doppler ultrasound examination shows no vascularity within the mass. In addition, ultrasonographic appearance varies with the maturation, compactness, and quantity of keratin present within an epidermoid cyst. In histology, diagnosis of epidermoid cysts include the following characteristics: (1) a cystic lesion located in the parenchyma of the testis; (2) the cyst containing keratinized debris or amorphous material; (3) the cyst wall composed of a fibrous epithelium; (4) absence of any teratomatous elements or dermal adnexal structures such as hair follicles or sebaceous glands within the cyst wall or testicular parenchyma; and (5) absence of any scars in the remainder of the testicular parenchyma, which might represent a burnt out, malignant germ cell tumor. Although ultrasound examination can reliably confirm the intratesticular location of the lesion, the findings are insufficient in specificity to allow a definitive diagnosis, and surgical exploration is usually undertaken. Recent studies have shown that, in addition to an ultrasound examination, other imaging tools may help differentiate epidermoid cysts from other solid intratesticular lesions. By using magnetic resonance imaging, epidermoid cysts have been described to have a target or “bull\'s eye” appearance, with a low signal intensity rim and a high intensity of inner structures in both T1- and T2-weighted images. With the use of a contrast-enhanced ultrasound, hyperenhancement is not found in the epidermoid cyst. In the pathogenesis of testicular germ cell tumors, the most consistent structural chromosomal abnormality is an isochromosome 12 p, which is a useful diagnostic tool for distinguishing testicular epidermoid cysts from tertoma.