Benign Intratesticular Cystic Lesions: US Features

Vikram S. Dogra, MD ; Ronald H. Gottlieb, MD ; Deborah J. Rubens, MD ; Lydia Liao, MD

1 From the Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, 11100 Euclid Ave, Cleveland, OH 44106 (V.S.D.); and Department of Radiology, University of Rochester Medical Center, Rochester, NY (R.H.G., D.J.R., L.L.). Presented as an education exhibit at the 2000 RSNA scientific assembly. Received December 28, 2000; revision requested February 15, 2001, and received May 15; accepted May 29. Address correspondence to V.S.D.(e-mail:

Benign intratesticular lesions are rare, but recognition is important to avoid unnecessary surgical intervention. The ultrasonographic (US) features that help differentiate benign from malignant intratesticular lesions are emphasized by the authors. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage (infarction). US features of cystic malignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. Of the cystic malignant testicular tumors, which can occur anywhere in testicular parenchyma, teratomas are the most frequent to manifest as cystic masses. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. These cysts contain spermatozoa and can be septate. The US findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier.