Testicular Cystic Lesions

Testicular Cystic Lesions

Bhawan K. Paunipagar, MD, DNB

Michael P. Federle, MD, FACR



  • Non-Seminomatous Germ Cell Tumor

  • Intratesticular Cyst

  • Tubular Ectasia of Rete Testis

  • Tunica Albuginea Cyst

  • Testicular Abscess

Less Common

  • Tunica Vaginalis Cyst

  • Necrosis or Hemorrhage in Tumor

  • Epidermoid Cyst


Key Differential Diagnosis Issues

  • Testicular cysts are common (8-10% of men)

  • Most cystic neoplasms have “complex” features

    • Mural nodularity, hemorrhage, or necrosis

    • Flow on color Doppler imaging

Helpful Clues for Common Diagnoses

  • Non-Seminomatous Germ Cell Tumor

    • Teratomas are usually well-defined complex masses

      • Cysts are a common feature and may be anechoic or complex, depending on the cyst contents

    • Cystic necrosis of the tumor is not uncommon in other NSGCTs

  • Intratesticular Cyst

    • Simple cyst

    • 2-18 mm diameter

    • Near mediastinum testis

  • Tubular Ectasia of Rete Testis

    • Variable size cystic lesions near mediastinum testis

      • Turn transducer to elongate into tubular channels

    • No flow on color Doppler

    • May be bilateral, asymmetrical

    • Often with associated spermatocele

  • Tunica Albuginea Cyst

    • Within the tunica surrounding testis

    • Usually solitary, 2-3 mm diameter, can be septate

  • Testicular Abscess

    • Usually complication of epididymo-orchitis

    • Enlarged testis with hypoechoic or mixed pattern

    • Imaging alone cannot distinguish from tumor

Helpful Clues for Less Common Diagnoses

  • Tunica Vaginalis Cyst

    • Rare, arises from visceral or parietal layer of tunica vaginalis

    • Usually anechoic; may have septations or may contain echoes due to hemorrhage

  • Epidermoid Cyst

    • Contents are “cheesy” keratin

    • Occasionally anechoic but layered keratin often creates a lamellated, “onion skin” appearance

    • May have a calcified capsule

    • Presents as painless nodule in young man

Image Gallery

Transverse ultrasound shows a large, heterogeneous, intratesticular mass image with internal calcification image and intervening cysts image. Features suggest teratoma or teratomatous components in a mixed germ cell tumor.

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Aug 2, 2016 | Posted by in GENERAL | Comments Off on Testicular Cystic Lesions
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