Giant Scrotal Epidermoid Cyst Containing 600 g of Keratinous Material: A Rare Testis-Preserving Surgical Excision

Scrotal epidermoid cysts are uncommon benign lesions and rarely attain giant dimensions. We report a 60-year-old male who presented with a progressively enlarging left scrotal swelling of one year's duration associated with a dragging sensation for two to three months. There was no associated pain, urinary complaints, fever, trauma, discharge, or constitutional symptoms. Clinical examination revealed a large, nontender cystic swelling involving the left hemiscrotum, measuring approximately 12×10 cm, with multiple sebaceous cysts over the scrotal skin. The left testis was palpable separately from the swelling. Ultrasonography, contrast-enhanced computed tomography, and magnetic resonance imaging suggested a giant epidermoid cyst arising from the left scrotal sac. Complete surgical excision was performed under spinal anesthesia. Intraoperatively, approximately 600 g of thick, whitish, pultaceous keratinous material was evacuated, followed by complete excision of the cyst wall while preserving the left testis. Redundant scrotal skin was excised, and scrotoplasty was performed. No drain was placed. The patient was discharged on postoperative day 2 with scrotal support. Histopathological examination showed an epidermoid cyst with inflammation. Giant scrotal epidermoid cysts are exceedingly rare and may mimic other benign and malignant scrotal lesions. Complete surgical excision remains the treatment of choice and provides excellent functional and cosmetic outcomes.