Intra-abdominal vas deferens cyst

Abstract

We report a case of a 62-year-old man with complaints of lower abdominal pain who, on radiological investigations, was found to have an approximately 6-cm cystic lesion in the left iliac fossa region abutting the posterolateral wall of the urinary bladder. However, its origin could not be confirmed. On laparoscopy, the cyst was found to be arising from the vas deferens and was excised. Histopathology confirmed it to be arising from the vas deferens.

INTRODUCTION

Cysts of the lower male genitourinary tract are uncommon and are usually benign. Intra-abdominal location of such cysts is a rarity. These cysts are generally associated with other congenital abnormalities such as Zinner syndrome (triad of renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction). We report a case in which there was an isolated cyst arising from the vas deferens with no other malformations. To the best of our knowledge, there are only two previous reports of such a mass arising from the vas deferens.[1]

CASE REPORT

A 62-year-old male presented with complaints of nonspecific lower abdominal pain for 4 months. There was no other positive history. Blood and urine investigations were normal. Abdominal ultrasound showed a cystic lesion in the left iliac fossa region. Computed tomography of the abdomen revealed a 6 by 3.5-cm hypodense lesion on the left side abutting the posterolateral wall of the urinary bladder, with rest of the scan being normal [Figure 1]. Laparoscopy was done and the cyst was found to be located adjacent to the vas deferens and appeared to arise from it. Excision of the cyst along with the adjacent vas deferens was done, and histopathology report showed the cyst having pseudostratified epithelium with thickened blood vessels and confirmed it to be arising from the vas deferens. Postoperative recovery was uneventful.

Figure 1.

Arrow points to a well-defined nonenhancing hypodense lesion in the left pelvis abutting the posterolateral wall of the urinary bladder

DISCUSSION

Cysts of the lower male genitourinary tract can be intraprostatic or extraprostatic. They present challenging diagnostic abnormalities as they are uncommon and their origin is uncertain. Vas deferens cyst is a rare condition and can be congenital or caused by infection, obstruction, or neoplasia. Differentials include extraprostatic cysts such as cysts arising from seminal vesicle, vas deferens, and Cowper's duct. Furthermore, hydatid cyst of the vas deferens has been reported.[2] Symptoms such as recurrent urinary tract infection, infertility, and recurrent epididymo-orchitis may aid the diagnosis. Magnetic resonance imaging is the best radiological investigation as it can characterize the nature and pinpoint the origin of these cysts. Transrectal ultrasound can be used both as a diagnostic and therapeutic measure to aspirate the cyst. The urologist should be aware of the possibility of an intra-abdominal vas deferens cyst and that, as our case shows, could easily be treated with laparoscopic cyst excision.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given his consent for his images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.