The differential diagnosis according to the clinical feature

The differential diagnosis according to the clinical features and image characteristics of the intramedullary spinal cord tumors are described in Table 2. Ependymomas represent approximately 60% of all glial-based tumors of the spinal cord and filum terminale. Cyst formation and hemorrhage are common, especially at the tumor margins. Hemorrhage and calcification are more common in ependymomas than in astrocytomas. The incidence of polar and tumoral cysts is, however, similar to that of other intramedullary tumors and is not a distinguishing feature. Intramedullary ependymomas tend to be centrally located, with the cord often expanded symmetrically with sharp margins, unlike astrocytomas that tend to be eccentric and more infiltrative. On T1WIs, ependymomas may be hypointense or isointense to the spinal cord and are hyperintense on T2WIs. The enhancement of ependymomas is usually intense, and the borders are sharply marginated. Astrocytomas account for approximately 30% of intramedullary tumors and are the most common spinal cord tumor in children. Approximately 75% of astrocytomas occur in the cervical–thoracic regions, 20% in the distal cord, and 5% in the filum terminale. Astrocytomas are typically eccentric within the posterior spinal cord and are more infiltrative than ependymomas; therefore, these are difficult to resect completely. Tumoral cysts are often eccentrically located within the spinal cord and are small and irregular. Full diameter cord involvement and homogeneous high T2 signal intensity favor the diagnosis of astrocytoma. They are isointense to slightly hypointense on T1WIs and hyperintense on T2WIs. After gsk3 inhibitor administration, a uniform or heterogeneous enhancement pattern was seen on T1WIs. Spinal hemangioblastomas are uncommon and account for approximately 1–5% of spinal cord tumors. One-third of the cases are associated with von Hipel–Lindau syndrome. Approximately 50% of the tumors occur in the thoracic cord and 40% in the cervical region. Lesions are located mainly on the dorsal surface of the cord. The typical MR appearance is that of a large intramedullary cyst with a mural nodule. The signal intensity of hemangioblastomas is variable on T1WIs and hyperintense on T2WIs. The cysts can be of varying signal intensity on the T1- and T2-weighted sequences, depending on the protein content. Serpentine flow coids may be present, indicating vessels. Spinal angiography usually shows an intense tumor stain and draining veins that are considered to be characteristic. The surgical risk factor includes venous air embolism, deep venous thrombosis, pulmonary embolism, hemorrhage, cerebrospinal fluid leak, pseudomeningocele formation, wound infection, urinary dysfunction, and motor and sensory deficits. Myelotomy is an essential step for the exposure and subsequent removal in most cases of intramedullary tumors. A posterior longitudinal incision lying exactly over the midline is universally believed to be the safest way to perform a myelotomy. The outcome for the patient is particularly sensory deficits. In our case, the patient had suffered from paresthesia in both hands but recovered within 1 week after surgery. Complete removal of intramedullary neurinomas can be achieved with a very good clinical outcome, and complete surgical resection is seldom, if ever, associated with later recurrence. Subtotal excision has been reported to result in local tumor recurrence. Therefore, if there is no preoperative differential diagnosis with MRI, an intraoperative histological examination is helpful for this purpose. A schwannoma can be expected to be cured by complete resection.
Conclusion
Introduction Extratesticular tumors are more common than intratesticular tumors, and more than 95% of intratesticular tumors are malignant. Benign intratesticular tumors are rare and represent less than 1% of all testicular tumors. Epidermoid cyst of the testis is a rare benign intratesticular tumor. Radical orchiectomy is the standard procedure of treatment for malignant testicular tumors. Therefore, determining modes for testis preservation is extremely important for benign intratesticular tumors. Ultrasonography is the modality of choice for the characterization of palpable testicular lesions. This study presents a case of an epidermoid cyst of the testis and a review of sonographic images and pathologic features of the epidermoid cyst reported in the literature.