Cystic dysplasia of the rete testis accompanying ipsilateral renal agenesis in a young adult: a case report.

A 31-year-old man with left-sided testicular pain lasting a couple of months was referred to our urology department due to a suspected testicular tumor. Physical examination showed a hard, thickened, and small left testis on palpation with a diffuse, inhomogeneous ultrasonographic appearance. After a urologic examination, a left-sided inguinal orchiectomy was performed. The testis, epididymis, and spermatic cord were sent to pathology. Gross examination revealed a cystic cavity filled with brown fluid and the surrounding brownish parenchyma measuring up to 3.5 cm in diameter. Histologic examination showed a cystically dilated rete testis lined with cuboidal epithelium and a positive immunohistochemical reaction to cytokeratins. Microscopically, the cystic cavity was a pseudocyst filled with extravasated erythrocytes and abundant clusters of siderophages. The siderophages extended into the testicular parenchyma, surrounding the seminiferous tubules and spreading out around the ducts of the epididymis, which were also cystically dilated with siderophages inside their lumina. On the basis of clinical data, histological, and immunohistochemical analysis, the patient was diagnosed with cystic dysplasia of the rete testis. The literature shows an association between cystic dysplasia of the rete testis and ipsilateral genitourinary anomalies. Therefore, our patient underwent a multi-slice computed tomography scan, which revealed ipsilateral renal agenesis, a right seminal vesicle cyst reaching up to the iliac arteries, and a multicystic formation cranial to the prostate.

Tubular ectasia of the rete testis in an Angus bull.

An 18-month-old Angus bull presented to Auburn University College of Veterinary Medicine for a routine breeding soundness evaluation and lameness evaluation. He was classified as deferred potential breeder due to a lameness and was donated to the university. Following treatment, the bull's lameness resolved. He passed the breeding soundness examination in accordance with the Society for Theriogenology standards. However, avascular dilated areas at the level of the mediastinum testis of the right testicle were detected via Doppler ultrasonography. A high level of vascularity is routinely seen with neoplasia, such as teratomas. Due to the lack of vascularity, a presumptive diagnosis of tubular ectasia of the rete testis was made. The bull was castrated. The right testicle was submitted for histopathology revealing a definitive diagnosis of tubular ectasia of the rete testis.

Spontaneous regression of cystic dysplasia of the rete testis in an 18-month-old boy: the key role of ultrasonography.

Cystic dysplasia of the rete testis (CDT) is a rare cause of scrotal swelling in children. It is a congenital disorder and it can be associated with other genitourinary abnormalities. At present, there is no clear consensus on treatment. Surgical approach has traditionally been the treatment of choice, while, more recently, conservative approach has been applied, justified by the benign nature of the lesion and after few cases of spontaneous regression have been documented. Ultrasonography, supported by negative tumor markers, plays a key role in the diagnostic work up and during observational follow-up. We report a further case of spontaneous regression of suspected CDT in an 18-month-old boy, who has been followed with clinic and ultrasonographic checks.

Cystic Dysplasia of the Rete Testis: Does Pathophysiology Guide Management?

Cystic dysplasia of the rete testis (CDT) is a rare, benign, cause of testicular mass in the pediatric population. The mass appears on sonography as multiple small cysts of varying size surrounded by normal or compressed testicular tissue. CDT is often associated with other genitourinary anomalies, commonly presenting with agenesis or dysplasia of the ipsilateral kidney. The pathophysiology and the management remains controversial. We report a case of a 3-year-old presenting with an enlarged testicular mass later presumed to be CDT associated with ipsilateral renal agenesis, review the literature, and propose an evaluation and management algorithm.

Tubular ectasia of the rete testis (TERT). Differential diagnosis of cystic testicular disorders.

The ultrasound scan plays an essential role in the urological-andrological diagnosis. High-resolution transducers (8-15 MHz) make it possible to prove increasingly small changes. The assessment of cystic masses in the testis can also be difficult for experienced doctors. However, a precise diagnosis is crucial for the patient to avoid further invasive diagnostics and therapy. The differential diagnosis of benign intra-testicular cystic lesions include the tubular ectasia of the rete testis (TERT), the cystic dysplasia, epidermoid cysts, dermoid cysts, simple testicular cysts and cysts of the tunica albuginea. Malign testicular tumours with cystic changes are particularly the mature teratoma, carcinomas of the epididymis and metastasis. The following overview shows different sonographic images and interpretations with a particular focus on TERT.

[Relationship between ectasia of the rete testis and the volume of seminal vesicle cyst in the epididymal head: an ultrasonographic study].

OBJECTIVE: To explore the correlation between ectasia of the rete testis (ERT) and the volume of seminal vesicle cyst (SVC) in the epididymal head by ultrasonography. METHODS: This study included 36 cases of ERT diagnosed by color Doppler ultrasonography and complicated with SVC in the epididymal head (case group), and another 44 SVC cases without ERT (control group), all confirmed by surgery or fine-needle aspiration. We analyzed the differences in nationality, age, volume of SVC and resistance index of the afferent artery in the diseased testis between the two groups of patients. RESULTS: No statistically significant differences were observed between Chinese Uighurs and Hans (P > 0.05), nor in the mean age between the two groups of patients (P > 0.05). There were significant differences in the mean volume of SVC between the case and control groups ([2.081 +/- 1.147] cm3 vs [1.009 +/- 0.848 ] cm3, P < 0.01), but not in the resistance index of the afferent artery in the diseased testis (0.644 +/- 0.099 vs 0.608 +/- 0.116, P > 0.05). CONCLUSION: The volume of seminal vesicle cyst in the epididymal head plays a significant role in the formation of ectasia of the rete testis.

Sertoliform cystadenoma: a rare benign tumour of the rete testis.

Sertoliform cystadenoma of the rete testis represents an uncommon benign tumour. They appear in patients from 26 to 62 years of age. We describe a case of a 66-year-old man with a tumour in the area of the epididymal head. The tumour markers were not increased. Under the assumption of a malignant testicular tumour an inguinal orchiectomy was performed. The cut surface of this tumour was of grey/white color and showed small cysts. The tumour consisted of two compartments. The epithelial like tumour cells showed a sertoliform growth pattern and cystic dilatations. In between the tumour cells repeatedly actin expressing sclerotic areas could be recognized as the second tumour component. Proliferative activity was not increased. Immunohistochemically the tumour cells were positiv for inhibin, S-100, and CD 99. Alpha feto protein (AFP), human chorionic gonadotropin (ß-HCG) and placental alkaline phosphatase (PLAP) as well as synaptophysin, epithelial membrane antigene (EMA), and BCL-2 were not expressed. As far as we know this is the sixth reported case of this tumour. Because of the benign nature of this tumour the correct diagnosis is important for the intra- and postoperative management. Here we present a case of this rare tumour and discuss potential differential diagnosis. VIRTUAL SLIDES: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1956026143857335.

Cystic dysplasia of the rete testis: ultrasound and magnetic resonance imaging findings.

Cystic dysplasia of the testis is a rare congenital anomaly. It presents a diagnostic challenge to the pediatrician and should be distinguished from malignant lesions. We herewith present a two-month-old boy who presented with right inguinal swelling. Detailed investigations including ultrasound and magnetic resonance imaging helped in establishing the diagnosis of cystic dysplasia. To the best of our knowledge, our case is the first case of cystic dysplasia of the rete testis in the literature, which presented as undescended testis (inguinal swelling), with no associated renal or ureteric anomalies.

Unusual combination of bilateral testicular microlithiasis and tubular ectasia of the rete testis with left intra- and extratesticular varicocele in a 17-year-old boy.

We describe the rare combination of testicular microlithiasis, unilateral intra/extratesticular varicocele, and tubular ectasia of the rete testis in a 17-year-old boy who presented with testicular pain following a trauma. He had a prior history of undescended testis and orchiopexy in childhood. His workup included a normal abdominal ultrasound and a sperm analysis demonstrating a low sperm count with sperm dysmotility. A follow-up ultrasound was unchanged, and he has been managed conservatively. This combined set of findings has not been previously reported.

[Tubular ectasia of rete testis: a pitfall in ultrasonographic diagnostics of intratesticular cysts]. / Tubuläre Ektasie des Rete testis : Die Differenzialdiagnose von zystischen Veränderungen im Hoden.

BACKGROUND: Tubular ectasia of the rete testis (TERT) sonographically consists of a cluster of anechoic foci located at the mediastinum testis. TERT is important diagnostically, because it might be confused with malignant teratoma that may likewise contain cystic areas. PATIENTS AND METHODS: Twenty-four patients with TERT were identified sonographically. Ten of these patients underwent additional magnetic resonance imaging (1.5 T), and three had contrast-enhanced scrotal sonography. A descriptive analysis was done regarding clinical details and sizes of the single anechoic foci and of the entire areas involved with cystic changes. RESULTS: The median age of the patients with TERT was 60 years. Diagnosis was based on incidental findings or uncharacteristic symptoms in three quarters of the cases. The size of the single cysts was ≤ 3 mm, 4-6 mm and ≥ 7 mm in 12, 6 and 6 patients, respectively. The size of the entire area involved with cystic changes ranged from 0.5 x 1.2 cm to 2.5 x 3.0 cm. Six patients had TERT bilaterally, and 18 had concomitant spermatoceles. T2-weighted MRI demonstrated high signal intensity of the cystic areas. No signal enhancement was found in these areas after application of contrast agent. Contrast-enhanced sonography did not show uptake in the TERT areas. Histological evidence for dilatation of the rete testis was found in the two patients undergoing diagnostic surgery. CONCLUSIONS: TERT is a benign lesion of the testis that is increasingly detected sonographically. Knowledge of TERT is essential for the urologic sonographer to avoid unwarranted diagnostics and surgery as well as costs.

Imaging of non-neoplastic intratesticular masses.

The use of high-frequency ultrasound is increasing for the treatment of cystic, vascular, and solid non-neoplastic intratesticular masses. Cystic lesions examined include simple testicular cysts, tunica albuginea cysts, epidermoid cysts, tubular ectasia of rete testis, and intratesticular abscesses. Vascular lesions examined include intratesticular varicocele and intratesticular arteriovenous malformations. Solid lesions examined include fibrous pseudotumor of the testis, focal or segmental testicular infarct, fibrosis of the testis, testicular hematoma, congenital testicular adrenal rests, tuberculoma, and sarcoidosis. Gray-scale and color-flow Doppler sonography facilitate the visualization of the benign characteristics of the lesions. Magnetic resonance imaging can also help as a problem-solving modality in some cases.

Tubular ectasia of the rete testis associated with azoospermia: a case report.

Tubular ectasia of the rete testis (TERT) is a rare benign condition of the testis due to dilatation of the tubules of the rete testis. It must be differentiated from neoplastic disease of the testis clinically by patient's age, mode of presentation, tumour marker status and characteristic ultrasound and colour Doppler findings. Awareness and diagnosis of TERT should prevent unnecessary surgical intervention such as orchidectomy or biopsy. We report a case of severe bilateral tubular ectasia of the rete testis associated with azoospermia and review the relevant literature. This association has not been reported before in the literature to the best of our knowledge.

Cystic dilatation of the rete testis: a hidden diagnosis among infertile men.

Cystic dilatation of the rete testis, often also known as cystic ectasia of the rete testis, is a poorly understood condition that may be a cause of male infertility. This study examined the frequency of this condition in 749 men attending an infertility clinic with their partners. Of these 749 men, semen analysis was abnormal in 275 (37%) but apparently normal in 474 (63%). All the men attending the infertility clinic underwent a testicular ultrasound. Of these 749 men, the lesion was present in nine (1.2%); it was present bilaterally in three and unilaterally in six. In two men, one of whom had a bilateral lesion, the sperm count was normal. It is unclear whether this lesion is a cause of infertility but it is important that this condition is diagnosed so that its prevalence and its relationship to infertility can be ascertained.

The testis: the unusual, the rare and the bizarre.

Ultrasound is the preferred technique when imaging the scrotal contents. Although appearances of many of the more common abnormalities present the examiner with no diagnostic difficulty, the more unusual conditions may present a considerable challenge. Many normal variants, unusual and rare abnormalities may be instantly recognized once seen. The current review highlights the more unusual and rare conditions affecting the scrotal contents in order to allow the reader the opportunity to gain knowledge of their existence and to aid future interpretation of the difficult examination.

[Cystic ectasia of the rete testis]. / Ectasia quística de la rete testis.

OBJECTIVES: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component. METHODS: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period. RESULTS: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up. CONCLUSIONS: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

[Diagnosis of tubular ectasia of the rete testis with color flow Doppler imaging].

OBJECTIVE: To diagnose tubular ectasia of the rete testis with color flow Doppler imaging. METHODS: Sonographic, CDFI and pulse wave Doppler appearance in tubular ectasia of the rete testis was described. RESULTS: The characteristic ultrasound appearance with no associated soft-tissue abnormality and no flow on color flow Doppler imaging was seen. CONCLUSION: Color Doppler ultrasound imaging is the first choice for the diagnosis of tubular ectasia of the rete testis.

[Cystic dysplasia of rete testis associated with ipsilateral renal agenesis. Case report]. / Displasia cistica della rete testis associata ad agenesia renale omolaterale. Descrizione di un caso clinico.

Cystic dysplasia of the rete testis is a rare abnormality often associated with the ipsilateral agenesis of kidney. This malformation is due to a development defect of the mesonephric duct which is the cause of both the dilation of the testicular rete testis and renal agenesis. A case of this rare malformation, showing all the peculiarities described in the medical literature, is presented. A 3 years-4 months boy was examined for an asymptomatic left scrotal mass; thus, he underwent ultrasonography, which showed a multiple tubular and cystic dilatation of left rete testis, associated with the absence of left kidney, afterward confirmed by MAG3-radionuclide scan. Diagnosis was also validated by testicular biopsy. No surgery was required. The child is nowadays under observation and at 2-years follow-up he doesn't show any symptom. According to many authors, a conservative treatment of this benign congenital abnormality is suggested as well as serial ultrasonography to monitor the growth of the testicular mass, which in a longest follow-up, could require surgery. Malignant transformation nor infertility have never been described.