Epididymal Cyst and Differential Diagnosis of Swellings of Scrotum
This patient had Spermatocoele along with Indirect Inguinal hernia
Case Presentation
A 45 year patient came with complaints of pain in scrotum. There was a swelling near the root of left scrotum which came to the attention of patient recently. He pointed that there was a difference in size and shape of left and right side of scrotum. The swelling was soft, cystic and transilluminant. Also, there was a swelling in left Inguinal region which increased in size on coughing. An Inguinal hernioplasty and excision of the cystic lesion was done.
Discussion
Spermatocele is a retention cyst of tubule of rete testis or head of the epididymis
It contains clear fluid, spermatozoa and lymphocytes
Manifests as a palpable lump of the scrotum
Transilluminant, get above the swelling is positive
Spermatocoele and Differential Diagnosis of Swellings of Scrotum
Spermatocoele
Differential Diagnosis of Swellings in Scrotum
Hydrocoele - Collection of fluid secreted from tunica vaginalis
Inguinal Hernia - Get above the swelling is negative
Varicocoele - Dilated plexus of vein along the spermatic cord
Simple Epididymal Cyst - Not possible to differentiate anatomically, however sperms are typically found in a spermatocele but are absent in epididymal cyst
Neoplasm - Hard in consistency, irregular in shape
Epididymal cyst
Spermatocele
Congenital
Acquired retention cyst
Behind the body of the testis
Behind and above the testis
Multilocular
Unilocular
Looks like bunch of grapes
Looks like 3rd testis
Clear fluid
Barley water like fluid
Brilliantly transilluminant
Transilluminant
Management of Spermatocele
Usually asymptomatic, hence small cysts do not need treatment.
Larger cysts can be removed in case patient complaints of feeling of mass or pain
References
SRB’s Manual of Surgery (Purchase Link)