Cysts of the Tunica Albuginea—More Common Testicular Masses than Previously Thought?

Abstract

Cysts of the tunica albuginea have been considered very rare. Their clinical significance lies in their presentation as discrete testicular masses often diagnosed as malignancies prior to removal. We report our experience with 6 cases of cysts of the tunica albuginea over a 12-year period and review the relevant literature. It is obvious that these cysts can be both of epithelial and of mesothelial origin. Our material includes a cyst lined by a transitional-like epithelium, of a kind to our knowledge not reported previously. All of the cysts were found by palpation and they constituted 6% of the testicular tumours examined over the same period. High-resolution ultrasound examination can distinguish them from solid testicular masses, as in 2 cases here, thus enabling unnecessary operations to be avoided.

Sonographic Spectrum of Tunica Albuginea Cyst

“…[6] Under microscopic analysis, they are lined by non-ciliated cuboidal cells and contain serous fluid and cellular debris. [7]…”

Cysts of the Tunica Albuginea

“…Trauma and subsequent hemorrhage into the tunica albuginea could lead to cyst formation [1,2] secondary to trauma or infection [6,7] and possibly Mu¨llerian remnants [1,6,10]. Extratesticular lesions are usually benign and 95% of intratesticular lesions are malignant [2,5].…”

“…Cysts of the tunica albuginea are rare benign testicular tumors, with an overall incidence of 0.3-0.35% [4,8,10]. Patients may be presented with painful scrotal swelling, but often are asymptomatic and the cysts are discovered incidentally [9].…”

A case of testicular tunica albuginea cyst with psammoma body

“…Our case was a typical tunica albuginea cyst located at the mid‐anterior portion of the testis, discovered incidentally by the patient. Tunica albuginea cyst was first presumed to be due to local trauma or infection, but recently this cystic lesion is considered a form of inclusion cyst probably originating from a Mullerian or Wolffian duct remnant 1 . Tunica albuginea cysts have been reported with increasing frequency since the widespread use of ultrasonography.…”