Case Report: Adolescent epididymal cysts: three management approaches including a rare synchronous epididymal cyst and testicular torsion.

Introduction: Epididymal cysts are common benign lesions that typically present as painless scrotal masses. They predominantly occur in adult males but can also be found in adolescents, albeit with a higher likelihood of being overlooked at this age. Most patients experience relief or complete resolution of symptoms following conservative treatment. However, large cysts pose a risk of torsion. Torsion of an epididymal cyst in adolescents is clinically rare, with only a few reported cases to date, presenting diagnostic challenges for clinicians. Case descriptions: We report three cases of epididymal cysts in adolescents. Case 1 involved an asymptomatic cyst treated with aspiration, demonstrating significant cyst reduction at 4-month follow-up. Case 2 presented a persistent simple cyst managed by elective surgical excision with pathological confirmation after prolonged surveillance showed no resolution. Case 3 presented acutely with pain and suspected torsion on scrotal ultrasound, requiring emergency surgical intervention that revealed a 720° torsion of the epididymal cyst combined with 180° testicular torsion, treated testis detorsion and cyst excision. All cases achieved favorable outcomes. Conclusion: Epididymal cysts in adolescents warrant a tailored management strategy. While aspiration or elective excision are effective for non-acute cases, the potential for synchronous testicular torsion necessitates a high index of suspicion and prompt surgical exploration in acute presentations to preserve testicular viability.