Spermatocoele and Differential Diagnosis of Swellings in Scrotum

This patient had Spermatocoele along with Indirect Inguinal hernia

Case Presentation

• A 45 year patient came with complaints of pain in scrotum. There was a swelling near the root of left scrotum which came to the attention of patient recently. He pointed that there was a difference in size and shape of left and right side of scrotum. The swelling was soft, cystic and transilluminant. Also, there was a swelling in left Inguinal region which increased in size on coughing. An Inguinal hernioplasty and excision of the cystic lesion was done.

Discussion

• Spermatocele is a retention cyst of tubule of rete testis or head of the epididymis 
• It contains clear fluid, spermatozoa and lymphocytes 
• Manifests as a palpable lump of the scrotum
• Transilluminant, get above the swelling is positive

Spermatocoele

Differential Diagnosis of Swellings in Scrotum

• Hydrocoele - Collection of fluid secreted from tunica vaginalis
• Inguinal Hernia - Get above the swelling is negative
• Varicocoele - Dilated plexus of vein along the spermatic cord 
• Simple Epididymal Cyst - Not possible to differentiate anatomically, however sperms are typically found in a spermatocele but are absent in epididymal cyst  
• Neoplasm - Hard in consistency, irregular in shape

Epididymal cyst	Spermatocele
Congenital	Acquired retention cyst
Behind the body of the testis	Behind and above the testis
Multilocular	Unilocular
Looks like bunch of grapes	Looks like 3rd testis
Clear fluid	Barley water like fluid
Brilliantly transilluminant	Transilluminant

Management of Spermatocele

• Usually asymptomatic, hence small cysts do not need treatment. 
• Larger cysts can be removed in case patient complaints of feeling of mass or pain 

References

1. SRB's Manual of Surgery (Purchase Link)
2. http://radiopaedia.org/articles/epididymal-cyst
3. http://link.springer.com/article/10.1007/BF00300258