MedPix® Case: 6043 - Intratesticular Cysts (based on imaging characteristics)

38.107.191.89

MedPix® Teaching File Case No: 6043

Case Summary: 6043 - || - - || - -

Contributed by: Ralph H Pickard ( National Capital Consortium ) - || -

Approved by: Richard J. Choi ( Walter Reed Army Medical Center ) - || -

Diagnosis

Intratesticular Cysts (based on imaging characteristics)

Dx confirmed by

* Not Provided by Author *

Demographic

Age: 74 - Gender: man - caucasian

History

Testicular cysts noted on previous ultrasound.

Exam and Lab

Normal scrotal examination

Images

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Image: 1

Intratesticular cysts

Image: 2

Intratesticular cysts

Findings

Multiple simple-appearing cystic lesions within the testicles near the region of the medistinum testis.

Differential

Intratesticular cysts
Ectasia of the rete testis
Cystic malignancy
Teratoma
Mixed germ cell tumor

Patient Discussion

Some believe that intratesticular cysts may belong to the same pathophysiologic continuum as ectasia of the rete testis.

Treatment and Followup

No treatment necessary.
Some institutions might follow-up initially after a few months and then discontinue if no change is demonstrated.

Disease Topic

Testicular Cysts

Disease Discussion

Testicular cysts are relatively common. They are benign when they share the sonographic characteristics of other benign cyst found throughout the body:
1.) Anechoic
2.) Increased through-transmission
3.) Imperceptible wall without nodularity
4.) Well-defined posterior wall without nodularity

There are three types of benign cystic lesions in the testicle. Intratesticular cysts are found in up to 10% of testicular sonograms and are most common in the elderly. They are usually located near the mediastinum testis and may be part of a continuum that includes the second type of cystic lesion of the testicle: Tubular ectasia of the rete testis. The third type of testicular cyst is a cyst of the tunica albugenia. These can be firm and palpable since they are at the surface of the testicle but if they have a simple and classic appearance, they can be ignored.

The significance of these lesions is the differentiation of them from cystic malignancies of the testicles including teratomas and cystic mixed germ cell tumors. These malignancies, although they can have cystic components, usually contain solid components and teratomas commonly contain calcification.

Reference(s)

Kurtz AB, Middleton WD. Ultrasound: The Requisites. Mosby; 1996.pp 434-442

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