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Paraurethral Cyst Within the Corpus Cavernosum Urethrae
THE ,TOURNAL OF UROLOGY
VoL 76, No. 1, July 1956 Printed in U.S.A..
PARA.URETHRAL CYST WITHIN THE CORFGS CAVERNOSUlVI URETHRAE CHARLES G. WELLER
Cysts occurring within the urethra or arising from the prostate gland have been encountered on numerous occasions but, insofar as we have been able to ascertain, none has been previously observed within the corpus cavemosum urethrae.
FIG. 1. A, dissection of cyst from corpus cavernosum urethrae. B, gross specimen un. opened (external view). C, gross specimen bisected showing mucosal lining.
The case which we wish to report concerns Mr. S., a white man aged 33 years, who complained of a circumscribed, painless swelling on the ventral surface at the penoscrotal angle. lt measured approximately 1.5 by 1.0 cm., was tensely fluctuant and lay in the corpus spongiosum. The patient had heen aware of its Read at meeting of North Central Section of American Urological A,sociation, Chicago, Ill. September 26-0ctober 1, 1955.
94
PARATJHJ
ns
J.i'w. 2. A, mu cos al lining. X 430. B, mucosa! lining X970
presence for only 2 weeks. rrnthroscopy showed compression of the urethra in the region of the mass. There was no other intraurethral lesion. On ,June 2, 1955 the mass was exposed surgically and excised. It consisted of a tense cyst lying in the ventral portion of the corpus spongiosum. On removal no connection with the urethra was found. There was a thin layer of cavernm1::, tissue between the cyst and the urethral fioor. :VIicroscopic study showed tlw cyst to be lined by transitional columnar epithelium and filled with thick slightly green to brown, purulent secretion (Jigs. l and 2). nrnc,;ssro'\' .A complete review of the medical literature pertaining to urethral cysi:f, was made by vVesson 1 in 1925. Only sporadic case reports have appeared since that time, He classifies urethral cysts as follows: a) echinococcus cyst, b,l cysts ill connection with carcinoma of the prostate, e) Cowper's gland cysts, cl) LiUre's gland eysts, e) cystic adenoma, f) cystic dilatations of the utricle or ejaculatory ducts, g) retention cysts. They may be congenital, or acquired by either compression of ducts or vrcarious development of mucus glands. He states that, 1
\Yesson, \I. B.: C,·s1s of prostate and urethra. ,J. Fro!., 13: 605-6:12, 1D25.
96
CHARLES G. WELLER
":"? ·
--par.s pt"'05. ur!Zth.
Embryo 88 mm. lon9 Reconstruction of midsa9ittal section of urethra sh0\,vin9 anomalous ducts
cates area drawn above from. .Pit;ure 3-A
Fm. 3. A, reconstruction of midsagittal section of urethra showing anomalous ducts. B, dotted line in insert indicates area drawn from A. (After Johnson.)
"In the male it is generally considered that cysts of the anterior urethra arise from glands of Littre while those of the prostate, vesical orifice and posterior urethra originate in the prostatic tubules. Grunfeld, Schwerin and Gottfried have reported small intra-urethral cysts of the glands of Littre. Retention cysts due to occluded prostate gland ducts are the most interesting and the commonest." 1Vesson collected 55 cases from the literature, twenty-nine of which were prostatic in origin, and added four prostatic cysts of his own. Among these cases, he found only four definite and three questionable reports of cysts of the anterior urethra. All of these occurred within the urethral lumen. In a report on histologic studies of the urethra in the newborn, Montella 2 2
Montella, G.: Para-urethral glands and canaliculi in newborn infants. Pediatria, 47:
490--505, 1939.
PARAURETHRAL CYST WITHIN CORPUS CAVERNOSUM URETHRAE
97
A
Embryo 88 mm. lon9 Cross section of cavernous urethra showin(,'.1 anomalous cystic ducts
Embryo 88 mm. lon9 Cross section of cav
FIG. 4. A, cross-section of cavernous urethra showing anomalous cystic ducts. B, crosssection of cavernous urethra showing anomalous cystic ducts. (After Johnson.)
describes submucosal and mucosal glands, very few of which occurred on the ventral portion of the urethra. Montpellier and Laffargue 3 suggest as the cause of periurethral and vaginal cysts "the emhryologic migration and separation of glands." Langer and Schiftan4 believe that cysts in the mucosa are usually of inflammatory origin but rarely congenital. We are of the opinion that the lesion occasioning this paper could have been acquired through isolation of a urethral gland by destruction of its duct or it could have resulted from a congenital epithelial channel such as described by Franklin Johnson 5 in 1920 in his studies of the embryonic urethra. In one specimen Johnson reported epithelial channels along the ventral surface in the median line completely isolated from the urethra and containing a lumen (figs. 3 and 4). The following is a quotation from his article. "That these ducts are derivatives of the urethra cannot be questioned for their epithelium is similar to that of it. At first glance they give the appearance of being cut off epithelial glands, but this view of their origin is untenable, not only because of their larger size but because in certain places glands are seen arising from them. 3 Montpellier, J. and Laffargue: Pathogenesis of peri-urethral cysts. Bruxelles Med., 13: 515-525, 1933. 4 Langer, E. and Schiftan, W.: Cysts and varices of anterior urethra in young men. Dermat. Wchnschr., 91: 1562-64, 1930. 5 Johnson, F. P.: Later development of the urethra in the male. J. Urol., 4: 447, 1920.
98
r
CHARLES G. WELLER
"Why the formation of these peculiar structures and what their ultimate fate may be I am unable to state since in no other embryo have I seen anything comparable to them. Nor have I been able to find any reference to similar structures in the literature .... It is difficult to conceive that the ducts which I have just described are para-urethral ducts in the making, for they show no external opening and are far more extensive than the usually described paraurethral ducts." In the case we are reporting, the type of lining and absence of communication with the urethra argue for the congenital origin of this lesion. SUMMARY
A case of paraurethral cyst, probably of congenital origin, in the ventral portion of the corpus cavernosum urethrae is reported.
12 Fox St., Aurora, Ill.
VoL 76, No. 1, July 1956 Printed in U.S.A..
PARA.URETHRAL CYST WITHIN THE CORFGS CAVERNOSUlVI URETHRAE CHARLES G. WELLER
Cysts occurring within the urethra or arising from the prostate gland have been encountered on numerous occasions but, insofar as we have been able to ascertain, none has been previously observed within the corpus cavemosum urethrae.
FIG. 1. A, dissection of cyst from corpus cavernosum urethrae. B, gross specimen un. opened (external view). C, gross specimen bisected showing mucosal lining.
The case which we wish to report concerns Mr. S., a white man aged 33 years, who complained of a circumscribed, painless swelling on the ventral surface at the penoscrotal angle. lt measured approximately 1.5 by 1.0 cm., was tensely fluctuant and lay in the corpus spongiosum. The patient had heen aware of its Read at meeting of North Central Section of American Urological A,sociation, Chicago, Ill. September 26-0ctober 1, 1955.
94
PARATJHJ
ns
J.i'w. 2. A, mu cos al lining. X 430. B, mucosa! lining X970
presence for only 2 weeks. rrnthroscopy showed compression of the urethra in the region of the mass. There was no other intraurethral lesion. On ,June 2, 1955 the mass was exposed surgically and excised. It consisted of a tense cyst lying in the ventral portion of the corpus spongiosum. On removal no connection with the urethra was found. There was a thin layer of cavernm1::, tissue between the cyst and the urethral fioor. :VIicroscopic study showed tlw cyst to be lined by transitional columnar epithelium and filled with thick slightly green to brown, purulent secretion (Jigs. l and 2). nrnc,;ssro'\' .A complete review of the medical literature pertaining to urethral cysi:f, was made by vVesson 1 in 1925. Only sporadic case reports have appeared since that time, He classifies urethral cysts as follows: a) echinococcus cyst, b,l cysts ill connection with carcinoma of the prostate, e) Cowper's gland cysts, cl) LiUre's gland eysts, e) cystic adenoma, f) cystic dilatations of the utricle or ejaculatory ducts, g) retention cysts. They may be congenital, or acquired by either compression of ducts or vrcarious development of mucus glands. He states that, 1
\Yesson, \I. B.: C,·s1s of prostate and urethra. ,J. Fro!., 13: 605-6:12, 1D25.
96
CHARLES G. WELLER
":"? ·
--par.s pt"'05. ur!Zth.
Embryo 88 mm. lon9 Reconstruction of midsa9ittal section of urethra sh0\,vin9 anomalous ducts
cates area drawn above from. .Pit;ure 3-A
Fm. 3. A, reconstruction of midsagittal section of urethra showing anomalous ducts. B, dotted line in insert indicates area drawn from A. (After Johnson.)
"In the male it is generally considered that cysts of the anterior urethra arise from glands of Littre while those of the prostate, vesical orifice and posterior urethra originate in the prostatic tubules. Grunfeld, Schwerin and Gottfried have reported small intra-urethral cysts of the glands of Littre. Retention cysts due to occluded prostate gland ducts are the most interesting and the commonest." 1Vesson collected 55 cases from the literature, twenty-nine of which were prostatic in origin, and added four prostatic cysts of his own. Among these cases, he found only four definite and three questionable reports of cysts of the anterior urethra. All of these occurred within the urethral lumen. In a report on histologic studies of the urethra in the newborn, Montella 2 2
Montella, G.: Para-urethral glands and canaliculi in newborn infants. Pediatria, 47:
490--505, 1939.
PARAURETHRAL CYST WITHIN CORPUS CAVERNOSUM URETHRAE
97
A
Embryo 88 mm. lon9 Cross section of cavernous urethra showin(,'.1 anomalous cystic ducts
Embryo 88 mm. lon9 Cross section of cav
FIG. 4. A, cross-section of cavernous urethra showing anomalous cystic ducts. B, crosssection of cavernous urethra showing anomalous cystic ducts. (After Johnson.)
describes submucosal and mucosal glands, very few of which occurred on the ventral portion of the urethra. Montpellier and Laffargue 3 suggest as the cause of periurethral and vaginal cysts "the emhryologic migration and separation of glands." Langer and Schiftan4 believe that cysts in the mucosa are usually of inflammatory origin but rarely congenital. We are of the opinion that the lesion occasioning this paper could have been acquired through isolation of a urethral gland by destruction of its duct or it could have resulted from a congenital epithelial channel such as described by Franklin Johnson 5 in 1920 in his studies of the embryonic urethra. In one specimen Johnson reported epithelial channels along the ventral surface in the median line completely isolated from the urethra and containing a lumen (figs. 3 and 4). The following is a quotation from his article. "That these ducts are derivatives of the urethra cannot be questioned for their epithelium is similar to that of it. At first glance they give the appearance of being cut off epithelial glands, but this view of their origin is untenable, not only because of their larger size but because in certain places glands are seen arising from them. 3 Montpellier, J. and Laffargue: Pathogenesis of peri-urethral cysts. Bruxelles Med., 13: 515-525, 1933. 4 Langer, E. and Schiftan, W.: Cysts and varices of anterior urethra in young men. Dermat. Wchnschr., 91: 1562-64, 1930. 5 Johnson, F. P.: Later development of the urethra in the male. J. Urol., 4: 447, 1920.
98
r
CHARLES G. WELLER
"Why the formation of these peculiar structures and what their ultimate fate may be I am unable to state since in no other embryo have I seen anything comparable to them. Nor have I been able to find any reference to similar structures in the literature .... It is difficult to conceive that the ducts which I have just described are para-urethral ducts in the making, for they show no external opening and are far more extensive than the usually described paraurethral ducts." In the case we are reporting, the type of lining and absence of communication with the urethra argue for the congenital origin of this lesion. SUMMARY
A case of paraurethral cyst, probably of congenital origin, in the ventral portion of the corpus cavernosum urethrae is reported.
12 Fox St., Aurora, Ill.