巨大精囊囊腫似陰囊水腫的新診断方法-病例報告

李定廉、楊啟瑞

中國醫藥大學附設醫院 泌尿部

Novel diagnostic approach of giant spermatocele mimicking hydrocele: A case report

Ting-Lien Li, Chi-Ray Yang

Department of Urology, China Medical University Hospital, Taichung, Taiwan

Background

Spermatoceles are a common type of cystic scrotal lesion, often small and asymptomatic. They typically result from cystic dilations of the efferent ductules in the head of the epididymis. However, in rare instances, they can grow to a significant size, leading to discomfort, scrotal heaviness, raising concerns of a neoplasm, or necessitating medical intervention. Spermatoceles are usually diagnosed incidentally, and their true incidence remains unknown. In our presentation, we describe a rare case, and we confirmed the diagnosis through a bedside aspiration procedure. Microscopic examination of the aspirate revealed the presence of numerous spermatozoa, supporting the diagnosis.

Case presentation

We report the case of a 56-year-old male patient with a prior history of Warthin tumor, who had undergone a right parotidectomy. The patient presented with a persistent left scrotal enlargement for 2-3 months. Upon physical examination, a suspicious left hydrocele measuring approximately 6 x 5 cm was identified. The hydrocele was transparent and non-tender. Subsequent scrotal ultrasonography revealed the presence of a left scrotal hydrocele, measuring 6.77 x 4.44 mm. A diagnostic hydrocele fluid aspiration yielded the presence of sperm, leading to the suspicion of a left spermatocele. Consequently, the patient was recommended for a left spermatocelectomy. Following admission, the patient underwent a left spermatocelectomy and partial epididymectomy. The excised specimen measured about 7.5 x 8 x 2 cm and contained cystic content. Notably, the ligated part of the specimen was the connected area between the spermatocele and the epididymis. The pathological examination subsequently confirmed the diagnosis of spermatocele.

Conclusion

It's worth noting that the surgical approach for spermatocelectomy differs from that of hydrocelectomy. Distinguishing a spermatocele from a hydrocele through imaging diagnosis, such as ultrasound and MRI, is crucial. While a hydrocele typically envelops the testicle, a spermatocele displaces the adjacent testicle. However, in cases of substantial size, the diagnosis can still be challenging. To definitively diagnose a spermatocele, the presence of spermatozoa within the cyst fluid is required. Performing aspiration before the operation can ensure an accurate diagnosis, and a straightforward microscopic examination can help identify the fluid component, particularly the presence of sperm, if it exists.