Benign intratesticular cystic lesions: US features

Benign intratesticular lesions are rare, but recognition is important to av oid unnecessary surgical intervention. The ultrasonographic (US) features t hat help differentiate benign from malignant intratesticular lesions are em phasized by the authors. Benign lesions include intratesticular simple cyst s, tubular ectasia, epidermoid cyst, tunica albuginea. cyst, intratesticula r varicocele, abscess, and hemorrhage (infarction). US features of cystic m alignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies wi th the maturation, compactness, and quantity of keratin present. Of the cys tic malignant testicular tumors, which can occur anywhere in testicular par enchyma, teratomas are the most frequent to manifest as cystic masses. An a bnormal rind of parenchyma with increased echogenicity usually surrounds th ese lesions. An intratesticular spermatocele communicates with the seminife rous tubules, whereas simple ectasia of the rete testis does not do so dire ctly. These cysts contain spermatozoa and can be septate. The US findings o f intratesticular varicocele are similar to those of extratesticular varico cele and include multiple anechoic, serpiginous, tubular structures of vary ing sizes. Improvements in gray-scale and Doppler US technology allow subtl e distinctions between benign and malignant testicular lesions that were no t possible a decade earlier.