Dirk Schaper (Klinik für Kinderchirurgie Krankenhaus St. Elisabeth und St. Barbara in Halle)  

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13 Years  

Male  

Pelvis-Testis  

unknown  

Incidental findings in sonographic examination due to acute pain in the right scrotal area.
Left side without complaints with. On the right side, we found testicular torsion and could detorque the testes. The sonographic examination of the left side showed unchanged findings.
Palpatory findings showed morphologically normal testes and epididymis. There were two indolent, soft masses felt at the head of the epidydimis.  

The etiology of a spermatocele is not known in-depth. One assums that it could form due to an obstruction of the epididymal tubuli. This obstruction could be of inflammatory or traumatic origin.
If sperm are found in the cystic process, one can speak of a spermatocele. If there are no sperm found, it is an epididymal cyst.  

<- view Ultrasound 1

Ultrasound 1: 10x6mm large, echoless mass in the upper testicular pole/head of the epididymis.





<- view Ultrasound 2

Ultrasound 2: Shown are two echoless masses at the head of the epididymis. 8x6mm and 11x7mm





<- view Ultrasound 3

Ultrasound 3: Echoless mass at the upper pole of the testes.


 

Surgery / Histo  

Epididymal cyst, Epididymal lymphangioma, Tunica albuginea cyst, epidermoid cyst.  

In our patient, a prophylactic pexy was planned, so that in this surgical procedure, the cystic structures could be removed. It proved to be a spermatocele in histology.
Normally, a spermatocele is not an indication for surgery. Usually, the patients are symptomless and don't even know that they have it. 30% of the asymptomatic patients who are sonographically examined show a spermatocele.
A surgical indication is only warranted in pain and very large cysts, which can cause a feeling of heaviness. Since spermatoceles are rarely larger than 10 mm, a larger mass should be investigated further.
The most fit treatment is the open surgical removal through a scrotal cut. A puncture treatment is generally dismissed, due to the risk of infection. Sclerotherapy should not be considered in reproductive years, due to the risk of abacterial epididymitis.  

N/A  

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1. Medline:
Frauscher,F., Klauser, A.,Stenzl, A., Helweg, G.,Amort, B., zur Nedden,D.
US findings in the scrotum of extreme mountain bikers
Radiology 2001; 219:427-431

2. Medline:
Dogra,V.S., Gottlieb,R.H., Oka,M., Rubens,D.J.
Sonography of the scrotum
Radiology 2003; 227:18-36

3. Medline:
Absikafi,N.F.
Spermatocele
www.emedicine.com  

Spermatocele, Epididymal cyst, epididymis, sonography, testes, ultrasound, child, childhood, pediatric radiology  

Dirk Schaper. Spermatocele. PedRad [serial online] vol 5, no. 11.
URL: www.PedRad.info/?search=20051118133428