Often epididymal cysts are multiple and may be bilateral and small cysts may remain undetected and asymptomatic. Small cysts are tolerated by patients. However, once cysts get large (with size equivalent to the size of a testicle) they are, unsurprisingly, more likely to need removal and as they are cystic and fluid filled they are well defined, As they arise in the epididymis, the testis is palpable quite separately from the cyst (unlike a hydrocele where the testis is palpable within the fluid filled swelling).
Extratesticular, fluctuant, cystic swellings which transilluminate and are readily palpable separate from the body of the testis are epididymal cysts and do not usually need further investigation. These can readily be distinguished from testicular tumours which arise from the testis.