EURORAD ESR

Case 9789

Epidermoid cyst of the testis: value of MR imaging in preoperative characterisation

Author(s)
Aikaterini Ntoulia, Athina C. Tsili, Konstantinos Tsampoulas

University Hospital of Ioannina,
Clinical Radiology, Dept. Of Radiology;
Pl. Patgis 2 45332 Ioannina, Greece;
Email:a_tsili@yahoo.gr
 
Patient
male, 25 year(s)
 
 
  • Figure 1
    Epidermoid cyst
     

    Axial T1-weighted image. An intratesticular mass lesion is demonstrated in the upper pole of the right testis (arrow), with smooth, well defined margins. A hyperintense area is seen centrally (arrowhead).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    Transverse fat-suppressed T1-weighted image shows hyperintensity of the lesion center (arrowhead), corresponding to dense keratinised material and calcifications, on histology.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
  • Figure 2
    Epidermoid cyst
     

    Transverse T2-weighted image demonstrates the typical “onion-skin” appearance of the lesion (arrow), corresponding to the laminated layers of keratinised material, on pathology. Imaging findings were suggestive...

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    Sagittal T2-weighted image. The lesion (arrow) is surrounded by a rim of low signal intensity, detected on both T1 and T2-weighted images, corresponding to fibrous wall on pathology.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Image compression; Special Focus: Tissue characterisation;

    Coronal T2-weighted image. A central focus with low signal intensity can be discerned within the lesion (arrow), corresponding to area of hyperintensity on T1-weighted images.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
  • Figure 3
    Epidermoid cyst
     

    DW image (b=900 s/mm2) in axial plane demonstrates lesion hyperintensity (arrow), suggestive for significant water molecules diffusivity restriction due to the presence of dense internal material.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    Corresponding ADC map (Figure 3a). The ADC values of the lesion (arrow) are 0.68 s/mm2 (arrow), compared to those of the contralateral testis (1.08 s/mm2).

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
  • Figure 4
    Epidermoid cyst
     

    Dynamic contrast-enhanced image (early phase) in sagittal plane demonstrates no lesion (arrow) enhancement.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;

    Axial T1-weighted image with fat suppression after intravenous administration of gadolinium shows absence of contrast medium uptake (arrow), highly suggestive of lesion benignity.

     
    Area of Interest: Genital / Reproductive system male; Imaging Technique: MR; Procedure: Imaging sequences; Special Focus: Tissue characterisation;
     
     
Axial T1-weighted image. An intratesticular mass lesion is demonstrated in the upper pole of the right testis (arrow), with smooth, well defined margins. A hyperintense area is seen centrally (arrowhead).
 
Transverse fat-suppressed T1-weighted image shows hyperintensity of the lesion center (arrowhead), corresponding to dense keratinised material and calcifications, on histology.
 
Transverse T2-weighted image demonstrates the typical “onion-skin” appearance of the lesion (arrow), corresponding to the laminated layers of keratinised material, on pathology. Imaging findings were suggestive for the diagnosis of epidermoid cyst.
 
Sagittal T2-weighted image. The lesion (arrow) is surrounded by a rim of low signal intensity, detected on both T1 and T2-weighted images, corresponding to fibrous wall on pathology.
 
Coronal T2-weighted image. A central focus with low signal intensity can be discerned within the lesion (arrow), corresponding to area of hyperintensity on T1-weighted images.
 
DW image (b=900 s/mm2) in axial plane demonstrates lesion hyperintensity (arrow), suggestive for significant water molecules diffusivity restriction due to the presence of dense internal material.
 
Corresponding ADC map (Figure 3a). The ADC values of the lesion (arrow) are 0.68 s/mm2 (arrow), compared to those of the contralateral testis (1.08 s/mm2).
 
Dynamic contrast-enhanced image (early phase) in sagittal plane demonstrates no lesion (arrow) enhancement.
 
Axial T1-weighted image with fat suppression after intravenous administration of gadolinium shows absence of contrast medium uptake (arrow), highly suggestive of lesion benignity.
 
 
 
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