Multilocular Intratesticular Cyst with Testicular Microlithiasis

An 85-year-old man presented with painless enlargement of the left scrotum. Physical examination revealed small bilateral hydroceles, and the left testis was enlarged but smooth without palpable nodules (Figure 1). Scrotal ultrasonography demonstrated a multilocular cystic lesion in the left testis with a main cyst measuring approximately 3.0 cm. Bilateral testicular microlithiasis was also observed. Serum tumor markers were within normal limits. Computed tomography showed simple renal cysts without evidence of malignancy or lymphadenopathy (Figure 2). The patient was managed conservatively. At 36 months, ultrasonography demonstrated a stable multilocular cystic lesion consisting of a 3.2 cm main cyst, several smaller adjacent cysts, and epididymal cysts (Figure 3 and Figure 4). All cysts were well defined and anechoic with posterior acoustic enhancement, without mural thickening or solid components. A small contralateral cyst was also noted (Figure 5). Based on these findings, the lesions were considered benign. Follow-up was discontinued at the age of 88 years.

This case is notable for a multilocular intratesticular cyst occurring in an elderly patient with testicular microlithiasis and demonstrating long-term stability. Simple intratesticular cysts are typically small and solitary, whereas multilocular cysts are uncommon [1]. Ultrasonography plays a key role in diagnosis. Typical benign cysts appear as well-defined anechoic lesions with posterior acoustic enhancement, enabling conservative management. By contrast, mural irregularity or solid components raise concerns about malignancy [2]. An epidermoid cyst is an important differential diagnosis, often showing an “onion-ring” pattern. In this case, the absence of suspicious imaging findings and normal tumor markers supported a conservative approach, particularly given the patient’s advanced age. A limitation of this report is the lack of histopathological confirmation. Recognizing characteristic ultrasonographic features is important to avoid unnecessary surgical intervention.