Dirk Schaper, K. Gerlach (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara Halle/S.)  

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8 Weeks  

Male  

Pelvis-Testis  

congenital  

Presentation because of retention of the testes at 8 weeks of age. Right hemiscrotum was hypoplastic, the testis itself is, however, well-palpated in the right inguinal region. There is somewhat resistence. On the other side, the scrotum is well-developed with discrete testicular hydrocele. Beta-HCG and Alpha-Fetoprotein were unremarkable.  

Epididymal cysts are generally benign and spontaneously regress. They are often a chance finding of a sonographic examination of the male genitalia. They can, however, cause symptoms - especially when they are large and give the patient a weighted-down feeling. One finds epididymal cysts in children whose mothers were treated with Diethylstilbestrol (DES). But also children who have testicular retention, cystic fibrosis and von Hippel-Lindau's Disease have increased incidence of epididymal cysts. A connection with the autosomal-dominant passed on disease of Polycystic Kidney Disease is being discussed.
Wollin et al. saw developmental rudimentary structures of the epididymis which had no connection to the tubule system of the epididymis.
Others see a hormonal cause as a leading cause and categorize the epididymal cyst as a testicular dysgenesis.
The increased incidence in connection to a maldescendent testis is not able to be explained at this time. How epididymal obstruction or an abnormal hormonal reaction are the causes is still unclear.  

<- view Ultrasound 1

Ultrasound 1: A mass which is low in echoes in the epididymal head in testicular retention and testicular hydrocele.





<- view Ultrasound 2

Ultrasound 2: 6,3 x6,7 mm mass of the right epididymal head.





<- view Ultrasound 3

Ultrasound 3: Opposite side you see a 1,5mm large structure by the epididymis which is free of echoes.





<- view Ultrasound 4

Ultrasound 4: Opposite side you see a 1,5mm large structure by the epididymis which is free of echoes with a testicular hydrocele.





<- view OP-Situs 1

OP-Situs 1: OP: intraoperative findings

 

Surgery / Histo  

Cystic teratoma, large hydatide, hudatide cyst  

Because of the unclear mass and the danger of torsion with the testicular retention, we decided to operate. The epididymal cyst was scraped out, the hydatide was removed and the testes were pexated. We also found kidney tissue in the spermatic cord during surgery.
The sonographically seen hydatide of the opposite side was not operated on.  

N/A  

N/A  

1. Medline:
Homayoon,K.,Suhre,Ch.D., Steinhardt,G.F.
Epididymal Cysts in Children: Natural History.
J Urol. 2004 Mar; 171(3): 1247-6

2. Medline:
Wollin,M.,Marshall,F.F.,Fink,M.P.,Malhotra,R.,Diamond,D.A.
Abberant epididymal tissue: a significant clinical entity.
J Urol. 1987 138: 1247,  

Epididymis, Cyst, Testicular retention, Hydatide, Hydatid, Hydrocele, Retentio testis, Testis, Epididymal Cyst,Testicular Retention, child, childhood, pediatric radiology  

Dirk Schaper, K Gerlach. Epididymal Cyst with Testicular Retention, Hydatid and Hydrocele. PedRad [serial online] vol 5, no. 7.
URL: www.PedRad.info/?search=20050715104508