Saving the Testis: A Multimodal Approach to Testicular Epidermoid Cysts in the Adolescent Age Group

Testicular epidermoid cysts (TECs) are rare benign intratesticular lesions that can clinically and radiologically mimic malignant germ cell tumors. We report two cases of adolescent males presenting with painless testicular nodules. Imaging findings-characteristic concentric echogenic rings, absence of vascularity, and normal tumor markers-suggested TECs. In both cases, intraoperative frozen section confirmed the diagnosis, revealing cystic lesions lined by squamous epithelium and filled with lamellar keratin, allowing for testis-sparing surgery. These cases highlight the importance of combining imaging, serum biomarkers, and intraoperative pathology to support conservative management of benign testicular masses.