Epidermoid cyst of the testis: An atypical sonographic appearance

Epidermoid cyst in ureter: A case report

RATIONALE

Uro-originated epidermoid cysts, especially located in the upper urinary tract are rare and only 4 cases of epidermoid cyst occurring in the upper urinary tract have been reported worldwide so far. In the previous cases, the cysts were diagnosed as tumors and organs were removed.

PATIENT CONCERNS AND DIAGNOSIS

We report a case of epidermoid cyst in ureter in a 48-year-old female patient admitted to the local hospital suffering from paroxysmal pain in the right hypochondriac for 8 years.

INTERVENTIONS AND OUTCOMES

She underwent right ureteroscopy in order to rule out the possibility of urinary epithelial carcinoma. The tumor was pathological diagnosed as a benign ureterocyst epidermoid. Postoperatively, the patient showed good recovery. During the 24-month follow-up period, the patient remained well and free of complications.

CONCLUSION

This case illustrates that benign epidermoid cysts can appear in the ureter, although it is extremely rare. It also indicates that perioperative examinations must be exhaustive to avoid the further injury to the patients.

Ultrasonography of the scrotum: Revisiting a classic technique

Conventional US is the primary imaging modality for the evaluation of the scrotum, due to its high resolution, availability, cost-effectiveness and absence of ionizing radiation. Grayscale and color Doppler US provide a comprehensive assessment of scrotal diseases. The technique represents the mainstay for imaging of acute scrotum. US is highly accurate in the detection, localization and characterization of scrotal masses. Multiparametric US, including conventional US, contrast-enhanced US and tissue elastography has improved the diagnostic performance of the technique in the assessment of testicular diseases. MRI represents a valuable supplemental imaging tool for the investigation of scrotal pathology, mainly recommended in cases of indeterminate US findings. Recommendations recently issued by the European Society of Urogenital Radiology Scrotal and Penile Imaging Working Group (ESUR-SPIWG) refer to the use of scrotal sonography for the evaluation of pathologic entities, including testicular microlithiasis, small, non-palpable incidentally detected testicular masses, varicocele and scrotal trauma. In this review, the technical specifications for scrotal US and the normal sonographic findings are presented. Grayscale and color Doppler US findings of common acute scrotal diseases and scrotal masses are discussed. The complimentary role of multiparametric US and scrotal MRI is addressed. ESUR-SPIWG's guidelines are also reviewed.

Ultrasound morphological patterns of testicular tumours, correlation with histopathology

INTRODUCTION

Ultrasound (US) plays a key role in the detection of testicular tumours. However, reliable characterisation of testicular tumours with US is difficult. The purpose of this study was to investigate the morphological patterns of testicular tumours as seen on modern US imaging and correlate these with histology.

METHODS

The imaging features of 50 testicular tumours were analysed and compared with histology. The US appearance was categorized into 15 distinct morphological patterns.

RESULTS

Patient's age ranged from 0.5 to 85 years. Of the 50 tumours in our series, 49 were malignant. Nearly half of the malignancies were seminomatous germ cell tumours (SGCTs). Tumours ranged in size from 10 to 130 mm with considerable overlap of size between tumours of different histological type. Even small (10 mm) tumours in our cohort were malignant. SGCTs demonstrated a narrower range of morphological appearances than non-seminomatous germ cell tumours (NSGCTs). Calcification was common in both SGCT and NSGCTs. Multicomponent cystic-solid appearance was only seen in NSGCTs.

CONCLUSION

The differentiation of testicular tumours with US continues to be challenging. In this paper, we have demonstrated the diverse morphological patterns of testicular neoplasms and have proposed the study of tumour morphological features as a promising research direction.

Testicular epidermoid cyst: about a case report and a review of the literature

Background

The testicular epidermoid cyst is an exceptional benign tumor. The presumptive diagnosis is facilitated by the development of medical imaging (echo-Doppler, elastography, contrast-enhanced ultrasound, MRI). The confirmatory diagnosis is histological.

Case presentation

We report the case report of a 37-year-old man who had a history of repetitive orchitis. He had complained of right scrotal discomfort for 6 months with no associated urinary symptoms. We performed an extemporaneous biopsy given the uncertain diagnosis (Fig. 3), and the histological examination was in favor of a mature teratoma. This prompted us to perform a right orchidectomy. The postoperative was simple. The final histological examination tipped in favor of an epidermoid cyst of the testicle. The patient was seen again at one month, and his clinical examination was normal.

Conclusion

The testicular epidermal cyst is a rare benign tumor of the testicle. Currently, conservative surgery has become the gold standard thanks to the development of medical imaging to differentiate between the both forms of TEC, and it retains certain limits which lie in the differential diagnosis with the teratoma requiring large multicenter studies to better characterize these two entities.