Tubular ectasia of the testis

Clinical History

The patient presented with vague pain in the right testis for some time.

Imaging Findings

The patient presented with vague pain in the right testis for some time. Ultrasound of the testis was performed. This revealed an epididymal cyst, a normal left testes and multiple tubular structures in the region of the mediastinum testis. The structures showed no significant flow on Doppler scan nor any change in size on the Valsalva manoeuvre. The findings were consistent with tubular ectasia of the testis.

Discussion

Tubular ectasia of the testis is a benign condition, also know as cystic transformation of the rete testis, and results from dilatation of the efferent tubules, which causes ectasia and cystic transformation. The anastomotic ducts are located in the mediastinum testis, in which numerous seminiferous tubules drain and connect with the head of the epididymis. Although the origin of the ectasia is vague, it probably represents changes secondary to obstruction of the tubules following infection or trauma.

The cysts can be seen on sonography as fluid-filled structures. They occur in older men, over the age of 55 years. The lesions can be bilateral, but are often asymmetrical. The location is in or adjacent to the mediastinum testis, and may reach the edge of the testis. There is usually an associated ipsilateral epididymal cyst.

MRI findings have been described; the ectasia has homogeneous low signal intensity on T1-weighted images and is isointense on T2-weighted images.

This entity must be recognised to avoid unnecessary biopsy or orchiectomy. Intratesticular varicocele is a rare entity, which can have a similar appearance to tubular ectasia, but it increases in size on the Valsalva manoeuvre and shows blood flow. Cystic dysplasia of the testis is also a rare condition, associated with congenital abnormalities. Cystic malignant testicular tumours occur anywhere in the testis. Teratomas can present as a cystic tumour, although this is very rare.

Differential Diagnosis List

Final Diagnosis

Tubular ectasia of the testis

URL:	https://www.eurorad.org/case/1865
DOI:	10.1594/EURORAD/CASE.1865
ISSN:	1563-4086