Epidermoid.com

Materials and Methods

Between March 1. 1991, and March 31, 1998. five patients were examined in our radiology department for testicular lesions that were pathologically confirmed to be epidermoid cysts. Three patients underwent imaging examinations in our department (sonography and MR imaging in two patients. MR imaging after sonography that was not performed in our department in OflC patient). Two patients submitted sonograms obtained at other institutions 11r review. During this time period. fl() additional patients who had a pathologically confirmed testicular epidermoid cyst were seen at our institution. The patients were 15-36 years old and had no significant medical or surgical history. On physical cxamination, each patient had a nontender, finn testicular mass that had been present front I month to 5 years. Serum ı-hunian chononic gonadotropin and ct-Ictoprotein levels were normal in all patients. Four of the five patients were treated by radical orchiectomı and one patient hı enucleation of the lesion. All five patients underwent preoperative imaging with high-resolution sonographı using highfrequency linear transducers. An Ultramark 9 or ATL 3(XX) scanner (Advanced Technology Labratories, Bothell. WA) was used in three patients. an Acuson I 28 scanner (Acuson, Mountain View. CM in one patient, and a Quantum scanner (Siemens. lssaquah. WA) in one patient. Color Doppler assessment was perfornıed in two of the five patients. Three of the five patients also had MR cxaminations performed on a I .5-T scanner (Signa: General Electric Medical Systems. Milwaukee.
WI) with a surface coil using a standard scrotal imaging protocol [6]. Contrast-enhanced MR images were obtained in two patients alter the IV administration of 0. 1 mmol/kg of gadopentetate dinıeglumine. The MR images of one patient have been previously published [6].

Fig. 1A, 1B, 1C: 26-year-old man with firm, nontenden testicular mass that had been present for 2 years. Lesion was preoperatively diagnosed as epidermoid cyst and was enucleated.

1A, Transverse sonognam of scrotum shows 1.5 x 1.6 x 1.7 cm well-demarcated intratesticular mass with internal pattern of alternating hypoechoic and hypenechoic rings (”onion ring” appearance). Small amount offluid is present around testicle (arrow).

1B, Sagittal T2-weighted fast spin-echo MR image (TRITE, 5300/144) shows well-cmcumscnibed
intratesticulan mass. Note low-signal-intensity capsule (open arrow)
and alternating concentric rings of low (arrowhead) and high (straight arrow) signal
intensity. Small amount of fluid is present around testicle (curved arrow).

1C, Coronal contrast-enhanced Ti-weighted fat-suppressed gradient-echo MR image (150/2; flip angle, 900) reveals no enhancement of lesion.

Fig. 2: 21-year-old man who noted right testiculan mass during scrotal self-examination 1 month earlier.

Sagittal sonogram of scrotum shows 1 .7 x 1.7 x 1.8 cm right inferior testicuIar mass. Note subtle concentric ring pattern (straight arrows) at periphery of lesion. Center of lesion (curved arrow) is relatively more hyperechoic than remainder of lesion. Note lack of distal acoustic shadowing representing ‘target” appearance. No other imaging was performed. Primary testicular neoplasm was suspected, and patient underwent nadical onchiectomy.

Fig. 3: 15-year-old boy with firm testicular mass.

Transverse image from scrotal sonogram shows a 2.2 x 1.2 x 1.2 cm lobulated, sharply marginated lesion with markedly hyperechoic rim (straight arrow) with central echogenic focus (”target” appearance) (curved arrow) without distal acoustic shadowing.

Fig 4A, 4B, 4C: 24-year-old man with left scrotal mass that had been present for 5 years.

4A, Sagittal view from scrotal sonognam shows well-demarcated lesion that is hypoechoic relative to adjacent uninvolved testicle, with mild increased through-transmission of sound (black arrows). Note few punctate foci of hypenechogenicity (white arrows) without distal acoustic shadowing within mass.

4B, Axial Ti-weighted spin-echo MR image (TRITE, 500/i5) shows well-circumscribed lesion of uniform low signal intensity (arrow) compared with adjacent normal testicular panenchyma  [6].

4C, T2-weighted axial fast spin-echo MR image (4000/i i5) shows lesion to have high signal intensity approaching signal intensity of intrascrotal fluid (solid arrow). Irregular low-signal-intensity capsule is present (open arrow). (Reprinted with permission from [6].

Full Article and References»

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Source: American Roentgen Ray Society:173, November 1999

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