Sub-pubic cartilaginous cyst--diagnostic utility of CT-guided contrast injection

Rare case of retropubic parasymphyseal cyst in a male patient

INTRODUCTION

Retropubic parasymphyseal cysta are rare, and few cases have been reported in men.

CASE PRESENTATION

A 65-year-old male patient presented with a 6-month history of pelvic and perineal pain. Magnetic resonance imaging revealed a high-intensity, irregular-shaped mass extending from the pubic symphysis to the bladder. Contrast enhancement revealed no uptake in the central part of the mass, indicating a cystic component. Computed tomography showed erosion of the pubic symphysis and pubic osteophytes. Pathological findings of biopsy specimens revealed inflammatory fibrous tissue but no malignancy. The definitive diagnosis was retropubic parasymphyseal cyst associated with inflammation. The patient was treated with cefazolin from 1 day before surgery until postsurgical day 7. Oral antibiotic therapy was then prescribed for 1 month to maximize treatment. After 2 months, the patient's symptoms resolved.

CONCLUSION

Retropubic parasymphyseal cysts with inflammation and smaller asymptomatic cysts can be managed effectively with conservative or minimally invasive treatment.

Retropubic parasymphyseal cyst: A rare entity

We report a case of a retropubic parasymphyseal cyst in a 69-year-old multiparous female with a protracted history of metastatic small bowel carcinoid (neuroendocrine) tumor. Cysts related to the pubic symphysis are uncommon, and mostly reported in subpubic location. They may be confused with primary vulvar masses, malignant bone tumors or metastatic disease. In our case, encapsulation, lack of solid components or diffusion restriction, communication with the symphysis, lack of activity on Gallium-68-Dotatate PET/CT and signal characteristics on MRI similar to those previously reported in literature for subpubic cysts all aided in eventual diagnosis. We aim to remind the reader of this rare entity and its distinguishing features on imaging.

Subacute Urinary Retention due to a Subpubic Cartilaginous Cyst Treated with Surgical Resection and Internal Fixation: A Case Report and Review of the Literature

A subpubic cartilaginous cyst is a rare mass lesion derived from the pubic symphysis, which can cause acute or subacute urinary retention. We report a case of a subpubic cartilaginous cyst in a 62-year-old woman that caused lower abdominal pain and subacute urinary retention, requiring surgical resection. On physical examination, a hard, flexible, nontender mass, 4 cm in diameter, was palpable along the lower border of the pubic bone, extending to the perineum. Magnetic resonance imaging revealed a clearly distinct (3.8 cm × 3.8 cm × 7.2 cm) mass on the midpelvic side of the pelvis, centered on the pubic joint. We proceeded with en bloc resection of the mass, including a resection margin of 1 cm on either side. The bony defect was fixed with a locking plate. On pathological assessment, the mass was diagnosed as a subpubic cartilaginous cyst arising from the cartilage of the pubic symphysis. No tumor recurrence was identified over a 4-year follow-up. Based on our experience, we propose that en bloc resection of the mass, including a wider resection centered on the pubic symphysis, with internal fixation, is a possible treatment for a subpubic cartilaginous cystic mass lesion.

Sonographic appearance of a cartilaginous cyst from the symphysis pubis mimicking a mass in the urinary bladder

A suprapubic cartilaginous cyst from the symphysis pubis is a rare lesion, which may be asymptomatic or cause symptoms such as urinary retention and pelvic pain. It is thought to be secondary to degenerative changes in the symphysis pubis and usually occurs in multiparous women. We report the case of a suprapubic cartilaginous cyst in a 76-year-old asymptomatic woman, which mimicked a bladder mass on ultrasonography.

A subpubic cartilaginous cyst causing neurological and sexual symptoms in a 69-year-old man

INTRODUCTION

Subpubic cartilaginous cysts (SCCs) are rare.

AIM

This is the first reported case of a male patient presenting with neurological and sexual symptoms due to an SCC.

METHOD

We describe the clinical history of a patient who reported neuralgic pain, numbness in the groin and base of his penis, and loss of sexual function.

RESULTS

A magnetic resonance imaging revealed the presence of an SCC with associated mass effect. A conservative approach was adopted and within 12 months, the cyst had decreased in size and his symptoms had improved.

CONCLUSIONS

Men who present with erectile dysfunction and neurological symptoms merit a thorough assessment including appropriate investigation to exclude organic pathology.

Subpubic cartilaginous pseudocyst: orthopedic feature with urological consequences

Introduction. Masses arising from structures adjacent to the female urethra can cause obstructive urinary symptoms. Subpubic cartilaginous pseudocyst is a rare degenerative lesion of pubic symphysis that may cause these symptoms. Materials and Methods. A 61-year- and 57-year-old women presented with symptoms of difficult micturition and dyspareunia. Physical examination revealed a painless smooth, rounded, firm, and cystic mass, at the anterior vaginal wall of about 4 cm width. The mass caused inward deviation of the external urethral meatus. Cystoscopy and MRI were done. Results. Cystoscopy of case 1 (61 y) demonstrated anterior external urethral compression with normal urethral mucosa. Cystoscopy was not possible in case 2 (57 y) because the urethra could not be entered under local anesthesia. MRI showed almost the same findings in both cases: midline, rounded, and cystic mass ~3 × 3 × 4 cm, anterosuperior to the urethra, and posteroinferior to the pubic symphysis, with normal features of the urinary bladder. Open surgical excision of theses lesions was performed in both patients. Histopathologic assessment of the specimen obtained from both patients showed degenerated hyaline with areas of fibrinous and mucoid degeneration, a picture suggestive of cartilaginous subpubic pseudocyst. After 11-month and 4-month followup of patients numbers 1 and 2, respectively, there is no evidence of local recurrence of the lesion, either clinically or radiologically and both patients void empty. Conclusions. Subpubic cartilaginous pseudocysts are rare benign lesions with only 13 cases were reported in the literature. Patients present with a spectrum of gynecological and/or urological manifestations. Sizable lesions severely compressing the urethra need surgical excision to restore the voiding function.