Figure 1
Abdominal ultrasound
Cystic dysplasia of the seminal vesicles
SectionUroradiology & genital male imaging
Case TypeClinical Cases
AuthorsMayoral Campos V, Bonnet Carrón C, Carro Alonso B, Sancho Lozano L
Connected authors
39 years, male
Clinical History
We present the case of a 39-year-old man affected with several weeks of occasional
hematospermia. Such episodes were not related to any specific cause; the patient
referred a history of recurrent urinary tract infections. Morphological, biochemical and
hormonal blood parameters did not show any significant abnormality. Semen analysis
showed oligozoospermia.
hematospermia. Such episodes were not related to any specific cause; the patient
referred a history of recurrent urinary tract infections. Morphological, biochemical and
hormonal blood parameters did not show any significant abnormality. Semen analysis
showed oligozoospermia.
Imaging Findings
Abdominal ultrasound study showed a cystic multi-lobed mass of 86 x 55 x 55 mm,
localised in low pelvis, posterior to the normal bladder. The right kidney was not
visualised, and the left kidney was of regular size and structure.
Axial contrast enhanced CT examination showed a right renal hypoplasia with pyelo-
ureteral dilatation. The right ureter opened up distally into the multi-lobed mass
localised in pelvis that corresponded to a seminal vesicle cyst. The left pyelo-ureteral
system had no abnormalities.
localised in low pelvis, posterior to the normal bladder. The right kidney was not
visualised, and the left kidney was of regular size and structure.
Axial contrast enhanced CT examination showed a right renal hypoplasia with pyelo-
ureteral dilatation. The right ureter opened up distally into the multi-lobed mass
localised in pelvis that corresponded to a seminal vesicle cyst. The left pyelo-ureteral
system had no abnormalities.
Discussion
Seminal vesicles cysts are a rare condition, which may be congenital or acquired. [1, 2]
It is caused by an abnormality in the development of the Mesonephric or Wolffian duct.
[1-6] Frequently, these malformations are associated with several abnormalities such as
ectopic ureter, renal aplasia or dysplasia, or cysts of the seminal vesicles. The intimate
embryological relationship between genital and urinary tract explains the high incidence
of associated malformations.
80% of patients with seminal vesicle cysts have ipsilateral renal dysgenesia, 8% have
duplication of the collecting system and ectopic implantation of the ureter to the seminal
vesicle may also appear. [1, 2]
The clinical presentation is diverse, with asymptomatic patients in most cases. It can be
an incidental finding within the study of male infertility. [3] If there are any symptoms,
they usually start between 21-41 years of age, when the sexual maturation of men
is finished. [2] Other common clinical presentations include recurrent urinary tract
infection, hemospermia, ejaculatory pain or perineal discomfort. [4]
The diagnosis of this malformation is made either through clinical symptoms or through digital rectal examination. Imaging tests are essential for the diagnosis confirmation. Abdominal or trans-rectal ultrasound is performed for the initial evaluation of the majority of the cases, either after clinical suspicion or as an incidental finding. [5] CT examination or MRI are the gold standard tests for the final confirmation of this malformation. [6]
The treatment of these urological malformations should be restricted to symptomatic cases. Patients who remain asymptomatic (without pain or functional deformity) do not usually need treatment and observation is adequate. In patients with symptoms, ultrasound guided cyst aspiration or surgery, especially vesiculectomy with or without removal of the hypoplastic kidney [4], are the techniques chosen for the treatment of this condition.
Take Home Message:
Seminal vesicles cysts are a rare condition associated with an abnormal development
of the ipsilateral upper urinary tract. The treatment should be decided according to the
symptoms.
It is caused by an abnormality in the development of the Mesonephric or Wolffian duct.
[1-6] Frequently, these malformations are associated with several abnormalities such as
ectopic ureter, renal aplasia or dysplasia, or cysts of the seminal vesicles. The intimate
embryological relationship between genital and urinary tract explains the high incidence
of associated malformations.
80% of patients with seminal vesicle cysts have ipsilateral renal dysgenesia, 8% have
duplication of the collecting system and ectopic implantation of the ureter to the seminal
vesicle may also appear. [1, 2]
The clinical presentation is diverse, with asymptomatic patients in most cases. It can be
an incidental finding within the study of male infertility. [3] If there are any symptoms,
they usually start between 21-41 years of age, when the sexual maturation of men
is finished. [2] Other common clinical presentations include recurrent urinary tract
infection, hemospermia, ejaculatory pain or perineal discomfort. [4]
The diagnosis of this malformation is made either through clinical symptoms or through digital rectal examination. Imaging tests are essential for the diagnosis confirmation. Abdominal or trans-rectal ultrasound is performed for the initial evaluation of the majority of the cases, either after clinical suspicion or as an incidental finding. [5] CT examination or MRI are the gold standard tests for the final confirmation of this malformation. [6]
The treatment of these urological malformations should be restricted to symptomatic cases. Patients who remain asymptomatic (without pain or functional deformity) do not usually need treatment and observation is adequate. In patients with symptoms, ultrasound guided cyst aspiration or surgery, especially vesiculectomy with or without removal of the hypoplastic kidney [4], are the techniques chosen for the treatment of this condition.
Take Home Message:
Seminal vesicles cysts are a rare condition associated with an abnormal development
of the ipsilateral upper urinary tract. The treatment should be decided according to the
symptoms.
Differential Diagnosis List
Seminal vesicle cyst with renal hypoplasia and ectopic ureter.
Cyst of the seminal vesicles
Cyst of the Muller duct
Cyst of the urogenital sinus
Prostatic cyst
Final Diagnosis
Seminal vesicle cyst with renal hypoplasia and ectopic ureter.
References
[1] SUÁREZ ALIAGA, B;RODRÍGUEZ JIMÉNEZ, I (2007) Quiste de vesícula seminal con agenesia renal asociado a malformaciones vasculares. Presentación de un caso. Arch. Esp. Urol (60)9, 1134:1136 (PMID: 18077873)
[2] BERNARD, F.K.; ROBERT, R.H.; MICHAEL, M.L. y cols (1991) Congenital cystic disease of the seminal vesicle. Radiology 178: 207-211
[3] BEEBY, DI (1974) Seminal vesicle cyst associated with ipsilateral renal agenesis: case repost and review of literature. J Urol 112(1):120-2. (PMID: 4600664)
[4] CALAHORRA FERNÁNDEZ, FJ; GARCÍA CARDOSO, V; MONTERO RUBIO, R; M.J. CANCHO GIL, J; CRESPÍ MARTÍNEZ, F; VELA NAVARRETE, R (2002) Quiste gigante de vesícula seminal asociado con agenesia renal ipsilateral. Actas Urológicas españolas 26 (3): 218-223
[5] KENNEY, P.J; LEESON, M.D (1983) Congenital anomalies of the seminal vesicles:spectrum of computed tomographic findings. Radiology 149(1):247-51 (PMID: 6611933)
[6] KNEELAND JB, AUH YH, McCARRON JP, ZIRINSKY K, RUBENSTEIN WA, KAZAM E. (1985) Computed tomography, sonography, vesiculography and MR imaging of a seminal vesicle cyst. J Comput Assist Tomogr 9(5):964-6. (PMID: 3897303)
Case information
| URL: | https://www.eurorad.org/case/10136 |
| DOI: | 10.1594/EURORAD/CASE.10136 |
| ISSN: | 1563-4086 |
Figure 2
CT examination
Coronal enhanced CT examination showed right renal hypoplasia with dilatation of pyelo-ureteral system. The seminal vesicle showed cystic dysplasia.
Figure 3
Axial contrast enhanced CT examination
Right renal hypoplasia with dilatation of the pyelo-ureteral system. The right ureter opened into the polylobulated mass localised in low pelvis that corresponded to seminal vesicle cyst.
Normal left pyelo-ureteral system.
Abdominal ultrasound
Lesion of 86 x 55 x 55 mm localised in low pelvis, posterior to the normal bladder. The lesion showed multi-lobed morphology and homogeneous echogenicity, with increased sonic transmission suggestive of cystic lesion.
Ariño I, Department of Radiology, HCULB, Zaragoza, Spain.
Ariño I, Department of Radiology, HCULB, Zaragoza, Spain.
Longitudinal view: cystic mass localised posterior to the normal bladder.
Department of Radiology, HCULB, Zaragoza, Spain.
Department of Radiology, HCULB, Zaragoza, Spain.
CT examination
Coronal enhanced CT examination showed right renal hypoplasia with dilatation of pyelo-ureteral system. The seminal vesicle showed cystic dysplasia.
Ariño I, Department of Radiology, HCULB, Zaragoza, Spain.
Ariño I, Department of Radiology, HCULB, Zaragoza, Spain.
Axial contrast enhanced CT examination
Right renal hypoplasia with dilatation of the pyelo-ureteral system. The right ureter opened into the polylobulated mass localised in low pelvis that corresponded to seminal vesicle cyst.
Normal left pyelo-ureteral system.
Ariño I, Department of Radiology, HCULB, Zaragoza, Spain
Ariño I, Department of Radiology, HCULB, Zaragoza, Spain