Value of ultrasound and MR imaging in diagnosis of tubular ectasia of rete testis.

Abstract

Introduction: Tubular ectasia of the rete testis is a rare, cystic lesion of the testis which is a pathologically benign process, usually found bilaterally and incidentally, more common in men over the age of 55 years. The process is bilateral in approximately one-third of cases. Because only 5% of intratesticular tumours are benign, the main significance of this condition is that it must be differentiated from testicular neoplasm. Material and methods: We report a case of tubular ectasia of the rete testis in a 57-year-old man with right epididymal pain. Results: Serum tumour markers for testicular malignancy were not elevated. A scrotal ultrasound scan revealed both testes of normal dimensions. But, we found appearance of indeterminate intratesticular hypoechoic lesion without definite cystic spaces in the confluence of the mediastinum testis, without of mass effect and lack of internal vascularity, billateraly, with a loculated right hydrocoele posterior to the right testis. We made a MR imaging. On T2- weighted images this manifests as a hyperintense zone owing to the presence of fluid in the dilated small mediastinal tubules, but nointernal enhancement was seen after administration of gadolinium contrast. The patient was managed conservatively and repeat scrotal ultrasound scans at 1 and 6 months demonstrated no change in pathology. Conclusion: The use of ultrasonography and colour Doppler imaging is vital in identification of tubular ectasia of the rete testis and, therefore, may avoid unnecessary orchidectomy. When the sonographic findings are equivocal, MR imaging is warranted to confirm the diagnosis.