Case Report

A 20yrs old male presented to the surgical out patient department with a history of swelling of right testes for last three- four weeks only. On clinical examination right testes showed mild swelling but no redness. No signs of hydrocoele elicited.

Ultrasound (US) examination showed two target lesions measured about 9.0mm and 5.0mm size each around lower pole of right testes. Both the lesions were lying side by side. No Doppler flow identified through the mass. A provisional diagnosis of epidermoid cyst was suggested. The left testis was unremarkable. Epididymus were normal on both sides.

Unfortunately, the surgeon was not convinced with our provisional diagnosis. Therefore, orchitectomy was carried out. The pathological specimen confirmed the ultrasonographical diagnosis.

Discussion

Epidermoid cyst was first described in1942. Since than more than two hundred cases have been reported in the literature. In the majority of cases the lesion showed varied characteristics of ultrasound appearance. The changes varied from hyperreflectivity of wall to hyporeflectivity. The contents varied from pure cystic nature to target lesions or in the form of concentric rings.

Histopathological findings showed two circular sharply demarcated area of white tissue, the largest measures8mm in diameter. Section of circular tissue show central keratin squamous surrounded by well-differentiated squamous epithelium. The findings are consistent with epidermoid cyst.

Figure 1

Figure 1: Pathological specimen shows central keratin squamous surrounded by well-differentiated squamous epithelium.

Figure 2

Figure 2: Ultrasonography shows Target lesions noted in right testes

Figure 3

Figure 3: Same Testes in transverse section shows target lesions side by side.