[Epididymal cyst in von Hippel-Lindau syndrome: clinicopathologic analysis of 3 cases]

OBJECTIVE

To investigate the clinicopathologic features of epididymal cyst in von Hippel-Lindau (VHL) syndrome.

METHODS

We reviewed the clinical data of 3 epididymal cyst patients treated by surgery, and detected the expressions of HIF-1alpha, VEGF, alpha-SMA and CD34 in the epididymal tissue samples by the immunohistochemistry SP method.

RESULTS

All the 3 patients underwent surgical removal of the epididymal cyst. Immunohistochemistry of the epididymal tissues showed HIF-1alpha, VEGF, alpha-SMA and CD34 to be positive. All the 3 cases were confirmed to be VHL syndrome, 1 right after surgery, and the other 2 within 8 years postoperatively.

CONCLUSION

Epididymal cyst is a usual benign disease, which may occur independently of or be complicated by VHL syndrome. If immunohistochemistry of epididymal tissues shows HIF-1alpha, VEGF, alpha-SMA and CD34 to be positive, VHL syndrome should be considered, and further clinical examinations and post-operation follow-up are necessitated.

Torsion of testis with large epididymal cyst in a 57-year-old man: a case report

INTRODUCTION

Testicular torsion is a rare pathology in adults. While it generally develops as a consequence of certain congenital abnormalities in pediatric and adolescent patients, the exact mechanism in adults remains unclear.

CASE PRESENTATION

A 57-year-old man initially diagnosed with right epididiymal cyst, when presented with severe right-sided scrotal pain six months later, was found to have a 720-degree right testicular torsion on surgical exploration.

CONCLUSION

Testicular torsion should be considered in the differential diagnosis of acute scrotum, regardless of patient age. We report a case of testicular torsion in the elderly patient, which may offer a contribution to the literature regarding the etiology of adult testicular torsion.

Giant Spermatocele Mimicking Hydrocele: A Case Report

Spermatoceles are usually asymptomatic and often found incidentally during physical examination. We report a case of giant spermatocele that mimicked a hydrocele. A 55-year-old man suffered from right scrotal enlargement for several years. As the heavy sensation and scrotal soreness worsened in recent months, he came to our outpatient clinic for help. Hydrocele was suspected due to transilluminating appearance of the scrotal content. Surgical exploration was arranged and a giant spermatocele was found. Total excision of the spermatocele was performed and the patient recovered well. The specimen was sent for pathology and spermatocele with spermatozoa was noted.

Bilateral epidiymal cysts in an alpaca male used for breeding

A 4-year-old alpaca stud was presented for examination of his reproductive tract. Ultrasonographic examination of the gonads revealed 2 cystic structures associated with the head of each epididymis. Biopsies of each testicle evidenced mild testicular degeneration. Histopathologic examination of the gonads revealed cystic efferent ductules in the head of each epididymis.

Ectopic prostate tissue within the processus vaginalis: insights into prostate embryogenesis

We report an 11-year-old boy who presented with a scrotal mass superior to the epididymis in the processus vaginalis. The mass consisted of prostate tissue, including glands and fibromuscular stroma, communicating with a spermatocele. Strong immunostaining for prostate-specific antigen was seen in the glandular epithelium. Immunostaining for peanut agglutinin highlighted the luminal plasma membrane in a subset of epithelial cells, mainly those located around the periphery of the nodule. To the best of our knowledge, this represents the first report of a pediatric patient with ectopic prostate tissue located outside the urinary tract and the first instance altogether of ectopic prostate noted at this location. The young age of the patient, the lesion's constituents, and its location suggest that the finding represents a disorder of development.

Primary bilateral spermatocele

We report the case of a bilateral, relatively huge, multilocular spermatocele diagnosed at sonography with surgical and pathological correlation. A 45-year-old man presented with bilateral, large inguinoscrotal masses. He had had the masses since his adolescence and their size gradually increased in the past 5 years. Scrotal ultrasonographic examination showed cystic fluid masses that were 65 x 45 x 50 mm in size on the right and 55 x 45 x 40 mm in size on the left side in multilocular spaces. The cystic masses were excised via bilateral inguinoscrotal incision staying near the body of the epididymis. The patient had fathered three children with no fertility problem.

Torsion of spermatocele: a rare manifestation

Torsion of a spermatocele on its pedicle is an extremely rare clinical condition that mimics acute testicular torsion. This rare condition has not been well characterized. Here, we report a case of torsion of a spermatocele. The present case is the 5th case of torsion of a spermatocele and the first report in a patient with a history of scrotal trauma. A tender cystic mass adjacent to the normally appearing testicle in the scrotum is highly significant for the differentiation from other types of acute scrotum. Torsion of a spermatocele should be considered a differential diagnosis of acute scrotum in adolescents and adults.

Multilocular spermatocele: a case report

We describe a case of a multilocular spermatocele. Ultrasound examination revealed several cystic spaces at the head of the left epididymis. Epididymal tumor could not be excluded, and therefore surgical exploration was performed. Histopathological examination of the specimen revealed a multilocular spermatocele arising from the rete testis. Most spermatoceles remain small and rarely present marked clinical problems. but they are occasionally large, and may simulate a solid tumor.

Benign scrotal pathology: should all patients undergo surgery?

OBJECTIVE

To evaluate the justification for operative intervention in patients undergoing surgery for benign scrotal pathology, and to assess the associated morbidity.

PATIENTS AND METHODS

Consecutive patients in two surgical firms who underwent surgery for benign intrascrotal pathology over a 5-year period were studied retrospectively.

RESULTS

In all, 102 patients were included in the study (mean age 51.6 years, range 16-86). Most patients had either epididymal cysts (59) or hydroceles (31) or a combination of the two (eight). Some patients (37) underwent ultrasonography before surgery. The indications for surgery were deemed to be strong in 25% of patients but weak or absent in the remainder. Complications occurred in 31 patients, being minor in 18, but significant in 13, resulting in four re-admissions to hospital. There was no significant difference in the complication rate between those patients with strong indications for surgery (37%) and those with weak indications (28%).

CONCLUSIONS

Surgery for benign intrascrotal pathology is frequently undertaken for weak clinical indications and carries significant associated morbidity. This could be avoided in many cases by simple reassurance. Judicious use of ultrasonography is advised. A policy of selective surgical intervention is strongly advocated.

Spermatic granuloma in the ram: diagnosis by ultrasonography and semen characteristics

Ultrasonographic appearance of the testis and epididymis, and seminal characteristics, with regard to localization of spermatic granuloma were studied. In rams with spermatic granuloma (n = 9), diagnosed by clinical or ultrasonographic examinations before histopathological confirmation, localization of each lesion was recorded. Epididymal granulomas, caput and cauda, were seen as anechoic or hyperechoic areas with a distinct margin with or without a hyperechoic capsule. Granulomas in the testis were microscopic and, therefore, could not be detected by ultrasonography. Enlargement in the mediastinum testis was detected in all rams when there were granulomas in the caput. Heterogeneous testis parenchyma invaded by numerous hyperechoic foci, representing testicular degeneration, was associated with granulomas both in the epididymis and testis. Ultrasonographic appearance of the lesions did not differ with regard to season. Seminal characteristics varied between rams. It was concluded that ultrasonographic evaluation may give valuable information in the diagnosis of sperm granuloma in the ram.

Degeneration of the seminiferous epithelium with ageing is a cause of spermatoceles?

A spermatocele refers to the cystic accumulation of semen in the male reproductive tract. Although it is thought to be caused by narrowing of the lumen of the excurrent duct with resultant cystic dilatation of the duct, the pathogenesis of the narrowing remains unknown. In the present study, we histologically examined spontaneous spermatoceles in C3H/He mice to elucidate the pathogenesis of the lesions. Testes, efferent ducts, epididymides and vas deferens obtained from young and aged C3H/He mice were embedded in plastic for histological observation at the light microscopic level. It was found that spontaneous spermatoceles were localized in the rete testis and efferent ducts of aged mice, as seen in man. The dilated rete testis and efferent ducts contained many degenerated and aggregated germ cells derived from the exfoliated seminiferous epithelium in the aged testis. In particular, it was noted that the agglutinated germ cells obstructed the narrow lumen of the efferent ducts, resulting in the failure of transport of germ cells to the caput epididymis, and spermatoceles were consistently found in the region between the rete testis and the obstructed site in the efferent ducts. However, no inflammatory cell infiltration, traumatic injury or spermatic granulomas were found in the occluded region. These results suggest that agglutinated germ cells may occupy the narrow lumen of the efferent ducts, resulting in the formation of a spermatocele. It may be that a senile change to the seminiferous epithelium, which releases immature germ cells into the lumen of the seminiferous tubules, is the cause of this type of spermatocele.

[Calcified spermatocele simulating a neoplasm]

OBJECTIVE

To report a case of a spermatocele mimicking a paratesticular neoplasm.

METHODS

A 58-year-old man was admitted to our hospital complaining of paratesticular swelling; a firm mass was detected on physical examination. The ultrasound study showed a paratesticular mass with hyperechoic and hypoechoic areas and calcifications, mimicking a neoplasm. Orchidectomy was performed.

RESULTS

The anatomopathological study showed a paratesticular spermatocele with calcification.

CONCLUSION

The spermatocele can mimick a paratesticular neoplasm.

Tumours and tumour-like conditions of the para-testicular region--a study of morphological features

Twenty two patients with tumours or tumour-like conditions of the para-testicular region (PTR) were diagnosed over a 5 year period. Of these, 16 (73%) were benign with only one true neoplasm (papillary cystadenoma). The tumour-like conditions were comprised of 6 cases of adenomatous hyperplasia of epididymis, 4 cases of spermatic granuloma, 2 cases each of spermatocele and nodular-fibrous proliferation and one mesothelial cyst. Three patients with spermatic granuloma gave a history of trauma. No case of adenomatoid tumour was encountered. Six malignant neoplasms were diagnosed (27%) all of which were sarcomas. Five were primary to the PTR and one was a metastatic deposit from a primary leiomyoblastoma of the mesentery. Among the 5 primary sarcomas were 2 cases each of rhabdomyosarcoma and leiomyosarcoma, and 1 case of liposarcoma. The patient with leiomyoblastoma presented first with a measenteric mass which was followed a month later by a rapidly growing mass in the scrotum. Immunohistochemical staining (IHC) and Electron microscopy (EM) were done in this case. Intra-cytoplasmic myofilaments as well as desmosomes were observed. The patients ranged from 14 to 65 years of age and most presented with painless mass in the scrotum. Follow-up was not possible due to practical difficulties.

Intratesticular spermatocele

High resolution ultrasound has increased our awareness of benign testicular cysts that appear to arise from the intratesticular sperm conduit system of the intratesticular ducts of the mediastinum and rete testis. The location of these benign cysts in the area of the mediastinum and rete testis and the absence of signs of a germ cell tumor may permit testicle preservation. These benign cysts may contain sperm. We present a case of a benign sperm-containing cyst with visible communication to the rete testis, designated an intratesticular spermatocele and managed with testicle preservation.

[Bilateral spermatocele developed after vasectomy: a case report]

A rare case of bilateral spermatocele developed 17 years after vasectomy was presented. A forty-seven year old man visited to our hospital with a chief complaint of swelling of bilateral intrascrotal contents. Sonographic findings demonstrated multilocular lesions of the bilateral intrascrotal contents. Operative procedure revealed bilateral cysts originating from the caput of the epididymis. Bilateral epididymectomy were performed. It was diagnosed as spermatocele because of demonstration of spermatozoa in the cystic fluid. We concluded that bilateral spermatocele has been induced by prolonged increased pressure of the intraepididymal duct following vasectomy 17 years ago.

Aspiration cytology of palpable lesions of the scrotal content

To date, we have studied 89 palpable lesions of the scrotum, testicle, and epididymis using fine-needle aspiration cytology (FNAC). Cystic lesions (48.3%) and inflammatory pathology (25.8%) were the most frequent findings. Tumors accounted for 11.2% of results, with a slight predominance of the malignant varieties. In this article, we describe the cytopathology of the main entities and discuss the principal problems of differential diagnosis, especially among inflammatory processes, seminomas, and embryonal carcinomas. The cytopathological pattern of the neoplasias is highly characteristic, and this permits their diagnosis with great precision. FNAC is essentially nontraumatic and easy to carry out, but it requires considerable practice in its execution and in the interpretation of the aspirates. We believe FNAC to be the technique of choice for the study of the pathology of the scrotal content, and we think that it should be employed on the patient's very first visit. The main advantage of FNAC is avoiding delays in diagnosis.

Torsion of a spermatocele: a case report and review of the literature

We report a case of torsion of a spermatocele in an adolescent. This condition has been described previously in adults. We recommend its consideration in the differential diagnosis of the acute scrotum in adolescents.

[A case of bilateral spermatocele]

A case of bilateral spermatocele is reported. A 46-year-old man was admitted to our hospital complaining of bilateral scrotal swelling. We obtained a colorless, opalescent fluid which contained numerous spermatozoa. The fluid volume, pH and gravity obtained from right spermatocele were 85 ml, 6.8 and 1.005, respectively, and those obtained from left side were 40 ml, 6.8 and 1.006, respectively. Spermatocelectomy was done under lumbal anesthesia. Both spematocele were found near the body of the epididymis. The wall of spermatocele had on epithelial lining of cuboidal cells. Twenty two cases of spermatocele reported in Japan since 1951 are reviewed.

[Magnetic resonance tomography (MRT) of the scrotum--initial results and comparison with sonography. I: Normal anatomy and extratesticular pathology]

Magnetic resonance imaging (MRI) allows for precise assessment of all important anatomic structures of the scrotum. Because the differences in signal intensity on T2-weighted images are adequate and there is high detail and contrast resolution in surface coil technique, the delineation of normal and pathologic structures greater than 1 mm is possible. Imaging in the coronal plane is preferable to that in the axial and sagittal plane. Other advantages of MRI include the possibility of comparing both hemiscrota in one imaging plane and the assessment of the inguinal region. In addition, MRI is less dependent on the expertise of the investigator. For the assessment of extratesticular pathology, MRI has advantages over other imaging techniques - including sonography - since the delineation of pathologic changes is much clearer.

Torsion of spermatocele: a newly described entity with 2 case reports

We describe, to our knowledge, the first 2 cases of torsion of a spermatocele. This condition should be considered in the differential diagnosis of an acute scrotum in the adult.

Pseudomalignant cytologic presentation of spermatic hydrocele fluid

An unusual cytologic presentation of spermatic hydrocele fluid is reported. The aspirate contained highly atypical cells, exhibiting marked anisocytosis and nuclear abnormalities strongly suggestive of cancer. On histologic examination the lesion displayed pseudosarcomatous fasciitis in the cyst wall and foci of atypical reactive mesothelial hyperplasia in the lining. This case illustrates a potential pitfall in the cytology of spermatic hydrocele fluid.

Scrotal palpation

Proper examination of the scrotum consists of inspection, palpation and, if indicated, transillumination. Inspection may reveal the hypoplastic appearance of an undescended testicle; enlargement caused by a testicular mass; the "bag of worms" signifying a varicocele; findings typical of torsion of the spermatic cord, or the "blue dot" sign, which indicates torsion of the appendix testis or appendix epididymis. During palpation, the testis must be differentiated from the epididymis.

Spermatic granulomas of ischemic origin in the rat epididymis

The sequelae of the permanently reduced blood flow through the testes of rats, in which stenosis of the abdominal aorta had been produced by inserting an incomplete ligature between the two renal arteries, were studied. In a high proportion of animals, spermatic granulomas occurred unilaterally or bilaterally in the epididymides. Their development was proceded by an ischemic injury; the contents of the canaliculi penetrated into the interstitium, producing a marked macrophagic reaction, which developed after the 5th day. Simultaneously, ischemic lesions were observed in the testes.