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| Year : 2012 | Volume
: 23
| Issue : 3 | Page : 559-561 |
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| Cystic dysplasia of the rete testis: Ultrasound and magnetic resonance imaging findings |
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Abdelhady Taha Emam1, Fatma Mohamed Awad1, Essam A Elsayed2, Muneer Alghashi3
1 Department of Radiology, Cairo University, Egypt,
2 Department of Urology, King Fahd Military Medical Complex, Dhahran, Kingdom of Saudi Arabia,
3 Department of Histopathology, King Fahd Military Medical Complex, Dhahran, Kingdom of Saudi Arabia,
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| Date of Web Publication | 7-May-2012 |
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 Abstract | | |
Cystic dysplasia of the testis is a rare congenital anomaly. It presents a diagnostic challenge to the pediatrician and should be distinguished from malignant lesions. We herewith present a two-month-old boy who presented with right inguinal swelling. Detailed investigations including ultrasound and magnetic resonance imaging helped in establishing the diagnosis of cystic dysplasia. To the best of our knowledge, our case is the first case of cystic dysplasia of the rete testis in the literature, which presented as undescended testis (inguinal swelling), with no associated renal or ureteric anomalies.
How to cite this article:
Emam AT, Awad FM, Elsayed EA, Alghashi M. Cystic dysplasia of the rete testis: Ultrasound and magnetic resonance imaging findings. Saudi J Kidney Dis Transpl 2012;23:559-61 |
How to cite this URL:
Emam AT, Awad FM, Elsayed EA, Alghashi M. Cystic dysplasia of the rete testis: Ultrasound and magnetic resonance imaging findings. Saudi J Kidney Dis Transpl [serial online] 2012 [cited 2013 May 25];23:559-61. Available from: http://www.sjkdt.org/text.asp?2012/23/3/559/95808 |
| Introduction | |  |
Cystic dysplasia of the testis is a rare congenital anomaly and only 29 cases have been reported till date. [1] It represents a diagnostically challenging condition in the pediatric population [2] and must be distinguished from malignant lesions. [3] We are herewith reporting the diagnostic ultrasound (US) and magnetic resonance imaging (MRI) features of cystic dysplasia of the rete testis to increase awareness of the disorder.
| Case Report | | |
A two-month-old boy presented with right inguinal swelling. On examination, the right scrotal compartment was empty, with a possibility that the inguinal swelling was due to undescended testis. The left testicle was in its scrotal sac.
US examination of the right inguinal area showed a mass measuring about 1.83 cm × 2 cm × 2.5 cm, formed of variable-sized anechoic (cystic) round and tubular structures. One of the suggested differential diagnoses was unde-scended testis with cystic dysplasia. The kidneys were normal in size, shape and echogenicity, with a normal collecting system.
On MRI study, the lesion showed cystic changes manifested by low and high signal intensities on short and long TE sequences, respectively, with no contrast uptake on post-contrast series. It was seen at the internal inguinal ring. The right scrotal sac was empty. The left testis was retractile.
Tumor markers were measured. Human chorionic gonadotrophin (HCG) was negative. The serum alfafetoprotein level was elevated at 395.7 IU/mL (N <11.4 IU/mL), which was concomitant with benign neoplasm. Radical orchidectomy was performed. Gross examination exhibited a hilar multiloculated cystic lesion. Microscopic examination showed cystic spaces lined by benign-appearing monostratified epithelium with atrophy of the surrounding testicular parenchyma. These findings were consistent with the diagnosis of cystic dysplasia of the rete testis.
[Figure 1]a depicts the US picture showing cystic dysplasia of the rete undescended testis. [Figure 1]b shows axial MR images (T1WI and T2WI) and [Figure 1]c shows coronal MR images (T2WI and T1WI). [Figure 1]d depicts MRI pictures after intravenous contrast showing cystic changes in the undescended testis with no abnormal enhancement. [Figure 1]e shows microscopic features of the mass, which reveals variable-sized cystic dilatation of the rete testis and tubuli recti as well as compressed and atrophic seminiferous tubules. | Figure 1: a: US image showing multilocular cystic mass in the inguinal region.
Figure 1: b: Axial magnetic resonance imaging scan picture (T1WI) of the mass.
Figure 1: c: Coronal magnetic resonance imaging scan picture of the mass.
Figure 1: d: Coronal magnetic resonance image of the mass (T1 post-intravenous contrast).
Figure 1: e: Photomicrograph showing the microscopic features of the mass.
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| Discussion | | |
Cystic dysplasia of the testis is a rare congenital anomaly that results in the formation of numerous irregularly shaped cystic spaces in the mediastinum testis. [4] In the literature, this lesion is often associated with ipsilateral urogenital lesions such as renal agenesis or multicystic dysplasia of the kidney, in order of frequency. The pathogenesis is explained by the common embryologic origin of both organs. [5] The clinical presentation of such a disorder usually occurs in the pediatric age-group as an asymptomatic scrotal swelling that can mimic testicular tumors. [4] Our case presented as an inguinal swelling with ipsilateral undescended testicle.
The differential diagnosis includes intratesticular simple cyst, epidermoid cyst, tunica albuginea cyst, testicular teratoma, juvenile granulosa cell tumor-gonadal stromal tumor, cystic lymphangioma and testicular torsion. [6]
The age of the patient at presentation, examination features, tumor markers and sonographic appearance may assist in making a presumptive and occasionally definitive diagnosis pre-operatively. [6] Based on the findings of these tests, we put cystic dysplasia on top of the differential diagnosis in our case.
Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier. [2] Treatment options include orchidectomy, testicular-sparing excision of the cystic mass and non-operative surveillance. [3]
Our case is unique in that, to the best of our knowledge, it is the first case of cystic dysplasia of the rete testis presenting as undescended testis (inguinal swelling), with no associated renal or ureteric anomalies. Further, none of the previous articles presented MR images of the cystic dysplasia.
In summary, we report a rare case of pathologically confirmed cystic dysplasia of the rete testis presenting as undescended testicle shows cystic changes on US and MRI.
| References | | |
| 1. | Cottone JL Jr, Redman JF. Cystic dysplasia of the testis with terminal ureterectasis and renal absence: Evidence of involution of a dysplastic kidney? South Med J 2003;96:56-7 . 
[PUBMED] [FULLTEXT] |
| 2. | Smith PJ, DeSouza R, Roth DR. Cystic dysplasia of the rete testis. Urology 2008;72:230.
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| 3. | Mac New HG, Terry NE, Fowler CL. Cystic dysplasia of the rete testis. J Pediatr Surg 2008;43:768-70.
[PUBMED] [FULLTEXT] |
| 4. | Bhat ML, Rasool Z, Kadri SM, et al. Cystic dysplasia of testis: A case report. J Clin Pathol 2006;59:1002-3.
[PUBMED] [FULLTEXT] |
| 5. | Bouron-Dal Soglio D, Harvey I, Jovanovic M, Oligny LL, Fournet JC. Bilateral Cystic dysplasia of the rete testis with renal dysplasia. Pediatr Dev Pathol 2006;9:157-60.
[PUBMED] [FULLTEXT] |
| 6. | Calleja Escudero J, Pascual Samaniego M, Garrido Redondo M, Matas Gómez V, Fernández Domínguez L, Fernández del Busto E. Cystic testicular lesions in infancy. Actas Urol Esp 2004;28:602-5.
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Correspondence Address:
Fatma Mohamed Awad
King Fahd Military Medical Complex, Dhahran, Kingdom of Saudi Arabia
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