Rapidly growing Intra-Scrotal epidermal inclusion cyst: a case report

Epidermal inclusion cysts (EICs) are benign lesions lined by stratified squamous epithelium, most commonly arising in cutaneous or subcutaneous tissues. Within urology, they have been reported in the perineum, penis, testis, and scrotum, where they typically present as superficial, slow-growing swellings. Intra-scrotal localization with rapid enlargement is exceptionally rare and may mimic malignant pathology. We describe the case of a 26-year-old male who presented with a painless, rapidly enlarging scrotal mass of two months’ duration. The patient had no relevant medical or surgical history. Physical examination revealed a firm, non-reducible intra-scrotal mass without overlying skin changes. Imaging demonstrated a well-circumscribed cystic lesion measuring 9.0 × 6.4 × 6.1 cm, displacing but not infiltrating adjacent testicular structures. En bloc surgical excision was performed, and histopathological evaluation confirmed the diagnosis of a benign epidermal inclusion cyst. The postoperative course was uneventful, with no recurrence at six months’ follow-up. This case highlights an uncommon presentation of a large, rapidly progressive intra-scrotal epidermal inclusion cyst, reaching dimensions rarely documented in such a short interval. Awareness of this entity is crucial, as it may clinically and radiologically resemble malignant or other serious scrotal conditions. Complete surgical excision remains the mainstay of management, providing both diagnostic confirmation and curative treatment. Emerging minimally invasive modalities may hold future promise in selected cases.