CASE 2680 Published on 16.12.2003

Dilated seminal vesicle with multiple cysts

Section

Uroradiology & genital male imaging

Case Type

Clinical Cases

Authors

Chabanova E, Clasen-Linde E, Løgager V, Thomsen H

Patient

32 years, male

Clinical History
Increasing pain during voiding and ejaculation over the past 6 months
Imaging Findings
The patient experienced an increasing pain during voiding and ejaculation over the past 6 months.
Excretory urography showed absence of left kidney and collecting system, mass effect on the left lateral aspect of the bladder as well as hypertrophy of the right kidney and a normal right collecting system (Fig.1).
Ultrasonography revealed no left kidney and collecting system, but a dilated cystic seminal vesicle. The prostate appeared normal.
CT was performed in order to visualise the anatomy before surgery. It revealed the presence of a small dysplastic kidney and a slim ureter on the left side. A relatively dense mass appeared behind the bladder on the left side (Fig.2), not consistant with a cystic origin. The conditions in the small pelvis were not adequately revealed.
More detailed anatomical features of seminal vesicles were clarified by an MR examination. T2-weighted MR imaging clearly identified the mass as a dilated left seminal vesicle (Fig.3). The conclusion based on the MR examination has been : ectatic seminal vesicle, pressing onto bladder.
The patient subsequently underwent surgical exploration and excisions of the left seminal vesicle, the dysplastic kidney and ureter.
On gross examination the left kidney was small, measuring 2 x 1,5 x 4 cm with a 17 cm long, equally calibrated ureter. The seminal vesicle measured 6 cm with a 4 mm diameter. It had a 3,5 x 2,5 x 2 cm firm but elastic area on one end. On the cut surface, the firm area showed multiple cysts with a colloid-like content.
Microscopically, the kidney showed a mesenchyme with degenerative changes and small and rudimentary tubules, in areas with hyalinization. There were multiple abnormal venous and arterial collections. This is a picture consistent with renal dysplasia. Microscopy of the seminal vesicle showed multiple cysts and fibrosis (Fig.4).
Two months after surgery, the patient had fully recovered.
Discussion
In agenesis, absence of a kidney is due to failure of a ureteral bud to form at all, failure of a growing ureteral bud to encounter and induce metanephric tissue or absence of metanephric blastema. Renal agenesis often coexists with other anomalies. In particular, unilateral agenesis may be associated with absence of the ipsilateral gland and abnormalities of ipsilateral genital structures. In males, these include cysts of the seminal vesicles, absent vas deferens, hypoplastic or absent testes, and hypospadias. A congenital cystic disease of seminal vesicle is uncommon and rarely reported in literature [1-4]. Before surgery it is of utmost importance that anatomic conditions are clearly visualized.

MR imaging enables excellent anatomic details of pathologic changes in the seminal vesicles, when the combination of urography, sonography and CT scanning examinations has not been conclusive.
Differential Diagnosis List
Ectasis of left seminal vesicle with multiple cysts
Final Diagnosis
Ectasis of left seminal vesicle with multiple cysts
Case information
URL: https://www.eurorad.org/case/2680
DOI: 10.1594/EURORAD/CASE.2680
ISSN: 1563-4086