Two simple cysts of the same testis

Strategy for treating simple testicular cyst in adults

Simple testicular cyst is increasingly diagnosed because of the general availability of high-resolution ultrasound devices, although its management has been controversial. The authors report their experiences in managing large simple testicular cyst in two adults aged 56 and 68 years. The first patient was hospitalized with a presumptive diagnosis of left hydrocele, and the second patient was hospitalized with left simple testicular cyst. Both patients felt pain in the left scrotum. The maximum diameter of the cyst in both patients was more than 6 cm. The patients were successfully treated with orchiectomy with very good long-term results. The authors indicate that a careful study of the medical history, physical examination, and scrotal ultrasonography may facilitate an accurate preoperative diagnosis. Age, symptom, compliance with the surveillance of the patient, and the size and dynamic ultrasonographic changes of the cyst should all be considered in the selection of the treatment regimen. Such a study may be helpful in managing a simple testicular cyst.

Ultrasonography of simple intratesticular cysts: a 13 year experience in a single centre

Objectives

Simple intratesticular cysts are being reported more commonly due to the wider use of scrotal ultrasonography however, their management remains unclear. Treatment has included enucleation, radical orchidectomy (over fear of an associated malignancy) and a more conservative approach with serial ultrasonography (if a neoplastic cyst is clearly ruled out). In view of the benign nature of such cysts, even serial ultrasonography may be unnecessary. We evaluate the presentation, diagnosis and management of ultrasound-detected simple intratesticular cysts over a 13-year period.

Methods

Between May 1994 and August 2007, 24 men were found to have simple intratesticular cysts on scrotal ultrasonography. Records were analysed retrospectively to identify the clinicoradiologic findings and the management.

Results

Median follow up was 29.5 months (range 4 - 108 months). Only one patient became symptomatic with a cyst which increased in size by 13 mm over 15 months. Orchidectomy performed at the patient's request confirmed a benign simple cyst.

Conclusions

In our series, a significant change in size of the cyst with accompanying symptoms was observed in one case only. Asymptomatic patients with simple intratesticular cysts without associated features of bias towards malignancy can be discharged without need for further follow-up.

Chronic testicular pain: an overview

Chronic testicular pain (orchialgia, orchidynia or chronic scrotal pain) is common and well recognized but its pathophysiology is poorly understood. Currently treatment is largely empirical. This article aims to present an overview of its prevalence, possible aetiology and the available treatment options. The contribution of psychological factors is unclear, although some of these patients undoubtedly are depressed. Post vasectomy chronic testicular pain may be due to functional obstruction of the vas, or to spermatic granuloma. The surgical technique used may be relevant and the application of intraoperative local anaesthetic may have a role in reducing the risk. The importance of the sympathetic nervous system and the role of a possible alteration of the adrenergic receptors of the vas deferens in patients with chronic testicular pain are discussed. For patients failing to respond to conservative treatment, microsurgical denervation of the spermatic cord, epididymectomy and vasovasostomy have all shown a degree of relief. Unfortunately a small number of patients fail to respond to both conservative and more invasive treatment methods and for them the only available therapeutic option is inguinal orchiectomy.

A morphological study of simple testicular cysts in the ostrich (Struthio camelus)

Simple testicular cysts are rare in mammals and of unknown aetiology, but dietary conditions have been implicated in this phenomenon in poultry. This study characterises the structural features of simple intratesticular cysts in the ostrich. Seven testes from a total of 15 sexually mature ostriches slaughtered during the breeding season were used. The testes contained multifocal, fluid-filled, unilocular cysts which were lined by a simple squamous or low cuboidal epithelium and surrounded by a thick layer of fibrous connective tissue. The cysts developed within seminiferous tubules and displayed morphological features similar to those reported in man and domestic poultry. The testis parenchyma revealed several foci composed of intermingled normal seminiferous tubules and variably sized intratesticular cysts. The atrophic tubules lay within a mass of hyperplastic, fibroblastic intertubular connective tissue in the proximity of large cysts and their formation appeared to result from hydrostatic pressure exerted by cysts. Morphological evidence supports a continuous process of cyst formation in the affected testis and a concomitant progressive loss of atrophic seminiferous tubules. A pathogenetic scenario of cyst formation and the effect of simple cysts on testicular histology has been proposed. Although the course of this phenomenon remains unknown, its impact on the fertility of this economically important bird deserves closer scrutiny.

Bilateral intratesticular cysts--a specific entity

A case of bilateral testicular simple cysts was seen in a 79-year-old Chinese man. The cysts contained clear fluid and were lined with simple cuboidal epithelia. The histochemical and immunohistochemical findings of this case were presented with an effort to clarify the nature of the cyst. In addition, the clinicopathological features, differential diagnosis and proposed histogenesis of the documented testicular simple cysts in the literature were also reviewed.