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Torsion of a Spermatocele: A Case Report and Review of the Literature
0022-534 7/90/1434-0786$02.00/0 THE JOURNAL OF UROLOGY Copyright© 1990 by AMERICAN UROLOGICAL ASSOCIATION, INC.
Vol. 143, April
Printed in U.S.A.
TORSION OF A SPERMATOCELE: A CASE REPORT AND REVIEW OF THE LITERATURE RONALD I. KAYE
AND
WILLIAM J. CROMIE
From the Division of Urological Surgery, Albany Medical Center Hospital, Albany, New York
ABSTRACT
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. (J. Ural., 143: 786, 1990) The term spermatocele was first used by Guerin in 1785 to describe an inflammatory condition of the testicle. 1 A spermatocele is a cyst filled with fluid and spermatozoa arising in the rete testes, ductuli efferentes or epididymis. These cysts are outside the tunica vaginalis and usually transmit light. 2 We describe a case of torsion of a spermatocele that mimicked acute testicular torsion. CASE REPORT
N. C., a 13-year-old white boy, initially presented in May 1987 with a history of intermittent episodes of left scrotal enlargement 1 month in duration, occasionally associated with severe left testicular pain. At physical examination the left hemiscrotum appeared to be unremarkable. He was instructed to return during an acute episode. The patient presented on June 3 with these complaints and an increase in the size of the left hemiscrotum. Physical examination revealed 2 ovoid masses in the left hemiscrotum. The inferior mass was the left testicle, which was confirmed by brisk Doppler pulses. The large superior cystic mass was exquisitely tender and transmitted light. Laboratory data revealed a white blood count of 8,000 with a normal differential. Hemoglobin and hematocrit levels were normal, and the urinalysis was acellular. Scrotal ultrasound revealed a normal left testicle with a 3 X 5.5 cm. paratesticular fluid collection consistent with a hydrocele or spermatocele. As a result of the severe local discomfort and the perplexing findings, exploration was done through a left inguinal approach and a fluid-filled mass was found arising from the head of the epididymis. The tunica vaginalis was opened and a dusky fluidfilled mass was found with a 360-degree torsion at the base, indicating torsion of a large spermatocele (see figure). The spermatocele was excised and ligated at the junction of the epididymis and testicle. The testis was returned to the left hemiscrotum and the inguinal incision was closed in the standard manner. Convalescence was uneventful and the patient was discharged from the hospital 1 day postoperatively. Pathological examination of the specimen revealed a spermatocele and a portion of compressed epididymis. DISCUSSION
Torsion of a spermatocele is a rare clinical occurrence. In contrast, torsion of the spermatic cord, testis or testicular appendages is common in children and young adults. Jassie and Mahmood reported 2 cases of torsion of a spermatocele in adults. 1 A 20-year-old white man had a 2 cm. cyst arising from a long stalk from the head of the epididymis. The stalk had Accepted for publication November 22, 1989.
786
Normal testis with torsion of spermatocele
twisted 360 degrees, resulting in presenting symptoms similar to those in our patient. A 44-year-old white man was believed to have torsion of the spermatic cord or acute epididymitis. Exploration revealed a 2.5 cm. hemorrhagic cyst that arose from the head of the epididymis and was twisted 360 degrees. We report a case in an adolescent. Due to the unusual presenting symptoms and physical findings we would like to bring this unusual entity to the attention of clinicians. We recommend that it be considered in adolescents and adults in the differential diagnosis of the acute scrotum. REFERENCES
1. Jassie, M. P. and Mahmood, P.: Torsion of spermatocele: a newly described entity with 2 case reports. J. Urol., 133: 683, 1985.
2. Howards, S. S.: Surgery of the scrotum and its contents. In: Campbell's Urology, 5th ed. Edited by P. C. Walsh, R. F. Gittes, A. D. Perlmutter and T. A. Stamey. Philadelphia: W. B. Saunders Co., vol. 2, sect. XV, chapt. 84, p. 2973, 1986.
Vol. 143, April
Printed in U.S.A.
TORSION OF A SPERMATOCELE: A CASE REPORT AND REVIEW OF THE LITERATURE RONALD I. KAYE
AND
WILLIAM J. CROMIE
From the Division of Urological Surgery, Albany Medical Center Hospital, Albany, New York
ABSTRACT
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. (J. Ural., 143: 786, 1990) The term spermatocele was first used by Guerin in 1785 to describe an inflammatory condition of the testicle. 1 A spermatocele is a cyst filled with fluid and spermatozoa arising in the rete testes, ductuli efferentes or epididymis. These cysts are outside the tunica vaginalis and usually transmit light. 2 We describe a case of torsion of a spermatocele that mimicked acute testicular torsion. CASE REPORT
N. C., a 13-year-old white boy, initially presented in May 1987 with a history of intermittent episodes of left scrotal enlargement 1 month in duration, occasionally associated with severe left testicular pain. At physical examination the left hemiscrotum appeared to be unremarkable. He was instructed to return during an acute episode. The patient presented on June 3 with these complaints and an increase in the size of the left hemiscrotum. Physical examination revealed 2 ovoid masses in the left hemiscrotum. The inferior mass was the left testicle, which was confirmed by brisk Doppler pulses. The large superior cystic mass was exquisitely tender and transmitted light. Laboratory data revealed a white blood count of 8,000 with a normal differential. Hemoglobin and hematocrit levels were normal, and the urinalysis was acellular. Scrotal ultrasound revealed a normal left testicle with a 3 X 5.5 cm. paratesticular fluid collection consistent with a hydrocele or spermatocele. As a result of the severe local discomfort and the perplexing findings, exploration was done through a left inguinal approach and a fluid-filled mass was found arising from the head of the epididymis. The tunica vaginalis was opened and a dusky fluidfilled mass was found with a 360-degree torsion at the base, indicating torsion of a large spermatocele (see figure). The spermatocele was excised and ligated at the junction of the epididymis and testicle. The testis was returned to the left hemiscrotum and the inguinal incision was closed in the standard manner. Convalescence was uneventful and the patient was discharged from the hospital 1 day postoperatively. Pathological examination of the specimen revealed a spermatocele and a portion of compressed epididymis. DISCUSSION
Torsion of a spermatocele is a rare clinical occurrence. In contrast, torsion of the spermatic cord, testis or testicular appendages is common in children and young adults. Jassie and Mahmood reported 2 cases of torsion of a spermatocele in adults. 1 A 20-year-old white man had a 2 cm. cyst arising from a long stalk from the head of the epididymis. The stalk had Accepted for publication November 22, 1989.
786
Normal testis with torsion of spermatocele
twisted 360 degrees, resulting in presenting symptoms similar to those in our patient. A 44-year-old white man was believed to have torsion of the spermatic cord or acute epididymitis. Exploration revealed a 2.5 cm. hemorrhagic cyst that arose from the head of the epididymis and was twisted 360 degrees. We report a case in an adolescent. Due to the unusual presenting symptoms and physical findings we would like to bring this unusual entity to the attention of clinicians. We recommend that it be considered in adolescents and adults in the differential diagnosis of the acute scrotum. REFERENCES
1. Jassie, M. P. and Mahmood, P.: Torsion of spermatocele: a newly described entity with 2 case reports. J. Urol., 133: 683, 1985.
2. Howards, S. S.: Surgery of the scrotum and its contents. In: Campbell's Urology, 5th ed. Edited by P. C. Walsh, R. F. Gittes, A. D. Perlmutter and T. A. Stamey. Philadelphia: W. B. Saunders Co., vol. 2, sect. XV, chapt. 84, p. 2973, 1986.