A Tunica Albuginea Cyst

Adam J. Singer, MD

Disclosures

November 29, 2001

Introduction

A 40-year-old Caucasian man complained of a painful, hard, kernel-like mass on the anterolateral superior pole of his left testicle that had been present for 5 days. He denied urethral discharge, voiding complaints, sexually transmitted diseases, trauma, infection, and prior episodes of pain. His medical and surgical histories were unremarkable.

Physical examination was normal with the exception of a 2 to 3 mm, hard, nonmobile, smooth mass on the upper outer anterior aspect of the left testis and a 4 to 5 mm left spermatocele.

Complete blood count, urinalysis, alpha-fetoprotein, and beta human chorionic gonadotropin were within normal limits. A scrotal ultrasound was normal with the exception of a 2.7 mm x 3.3 mm cyst in the tunica albuginea of the left testicle and a 4.6 mm x 4.3 mm left spermatocele (Figs. 1a, 1b, 1c). There was no evidence of increased flow to the tunica albuginea cyst on color Doppler ultrasound.

(A), Ultrasound of left testicle demonstrates a cyst in the tunica albuginea. (B), Calipers measure cyst as 2.7 mm x 3.3 mm. (C), A 4.6 mm x 4.3 mm spermatocele is observed at the head of the left epididymis.

(A), Ultrasound of left testicle demonstrates a cyst in the tunica albuginea. (B), Calipers measure cyst as 2.7 mm x 3.3 mm. (C), A 4.6 mm x 4.3 mm spermatocele is observed at the head of the left epididymis.

(A), Ultrasound of left testicle demonstrates a cyst in the tunica albuginea. (B), Calipers measure cyst as 2.7 mm x 3.3 mm. (C), A 4.6 mm x 4.3 mm spermatocele is observed at the head of the left epididymis.

Question What do you recommend as the next step?

  1. Left radical orchiectomy

  2. Transscrotal incision and drainage of the cyst

  3. Computerized tomographic scan of the abdomen and pelvis to rule out metastasis

  4. Observation

View the correct answer.

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