Pediatric Testicular Epidermoid Cyst

• Etiology: Benign lesion with layers of keratinous debris lined with keratinizing squamous epithelium
• Imaging US:
  — Non-vascular and well-marginated intratesticular mass
  — May have characteristic lamellated onion skin or whorled appearance with alternating hyperechoic and hypoechoic rings
  — Some may have target appearance with halo of hypoechogenicity and central hyperechoic region
• DDX: Testicular germ cell tumor which tends to show vascularity, testicular teratoma, focal intratesticular granulomatous disease such as tuberculosis, focal testicular hemorrhage
• Complications:
• Treatment: Orchiectomy versus tumor sparing surgery
• Clinical:
  — Present with painless testicular mass
  — Usually in second to fourth decades
  — Most common benign testicular neoplasm

Radiology Cases of Testicular Epidermoid Cyst