Unusual Appearance of an Extratesticular Epidermal Inclusion Cyst of the Scrotum

A 44-year-old white man presented with a 4 year history of right scrotal mass. He had a prior excision of another scrotal mass at a different medical facility, which was reported as benign. He had no pain, fever, chills, nausea or vomiting. Urine analysis was normal. Prior medical history included insulin-dependent diabetes mellitus, arterial hypertension, coronary artery disease, and end-stage liver disease complicated by hepatocellular carcinoma treated with liver transplant. Because of the transplant, he was on immunosuppressive drugs. Physical examination showed a non-tender right scrotal mass measuring approximately 3 £ 3 cm, which was separate from the adjacent testis. No hernia or hydrocele was found. Ultrasound showed both testes with normal size, echo pattern and vascularity (Figs 1 and 2). Immediately above the right testis (Fig. 1), which measured 3.9 £ 2.4 £ 2.5 cm, there was an ovoid structure (Fig. 2) similar in echogenicity, shape and size (3.9 £ 2 £ 2.1 cm) to that of the testis. The only difference was that it had no detectable blood flow, and whereas the testis was surrounded by a small hydrocele, the mass was not. Both epididymes had minute cysts, and there were bilateral small hydroceles. The described structure was thought to represent a possible “sterile abscess”. The possibility of a torsed supernumerary testis seemed unlikely in view of the clinical absence of pain. The patient underwent surgical exploration with removal of a well-encapsulated cyst from the scrotal wall. On section, it showed a thick white, cheesy content. Pathology study indicated an EIC. Bacteriology was negative. The patient had an uneventful recovery.