Extra Scrotal Spermatocele – A Unique Case Presentation & Brief Review of literature

Spermatoceles are usually asymptomatic and rarely cause clinical problems like disturbing pain and infertility. Self -examination and physical examination are the most common ways spermatoceles are detected. They are frequently seen on scrotal ultrasound as an incidental finding usually being located within scrotum cephalic and occasionally posterior to the testis [1]. Case reports of spermatoceles presenting at unusual locations are extremely rare with an extensive literature search revealing only 3 such cases which are depicted in Table 1 [2-4]. This case hence adds to the scarce literature on spermatocele with unusual presentations (Table 1).

Table 1:Reported Cases of Spermatoceles Presenting at Unusual Locations.

60-year-old male presented to surgical OPD with complaints of a gradually progressing painless left inguinal swelling for 3 months following history of trivial blunt scrotal trauma without any urinary/ sexual complaints. The patient was initially managed as a case of chronic epididymitis by a private practitioner with medications and reported to our clinic due to lack of improvement from the prior treatment. Physical examination revealed approximately 5 × 3 cm inguinal swelling extending up to the superior aspect of the left hemiscrotum (Figure 1). Bilateral testicular, scrotal, and abdominal examination was unremarkable. Ultrasonography suggested a hypoechoic lesion with low-level echogenicity and irregular walls abutting the left testis with superior extension into the inguinal region (Figure 2). FNAC of the cystic lesion revealed clear fluid with mature spermatozoa that confirmed the diagnosis of a spermatocele with predominant extra scrotal location (Figures 1,2).

Spermatoceles are extra testicular lesions caused by cystic dilation of the efferent ductules filled with clear/milky fluid containing spermatozoa. They are generally found incidentally as single, unilateral, and mostly asymptomatic swellings [5]. The exact aetiology of spermatocele still remains obscure with the proposed hypothesis being shedding of senile seminiferous cells leading to obstruction and dilatation of the efferent ducts [6]. Spermatoceles are well characterized on ultrasonography, appearing as hypoechoic lesions with posterior acoustic enhancement and confirmed by Fine needle cytology which reveals cyst fluid-filled with mature spermatozoa [7]. Most spermatoceles are managed conservatively unless they are persistently symptomatic or when they trigger doubts of malignancy in which case they are managed by spermatocelectomy. Sclerotherapy using ethanolamine oleate forms another effective and safe therapeutic alternative to surgery with minimal side effects and low recurrence. Sclerotherapy in younger men is avoided owing to the danger of epididymitis and resulting infertility [8]. The patient was managed conservatively owing to a lack of distressing symptoms with FNAC proving partially therapeutic causing more than 50% reduction in swelling size and is currently on periodic clinical follow-ups.

Spermatoceles occurring at extra scrotal locations are extremely rare occurrences as is evident by the scant published literature. This report adds to the scarce literature and serves to alert the practicing urologist-surgeon to maintain a vigilant eye for abnormal presentations of a common disease by persistent usage of simple but effective physical examination techniques like the transillumination technique and scrotal ultrasonography which must be considered in the examination of all inguinal/ inguinoscrotal swellings keeping extra scrotal spermatoceles in the list of differential diagnosis.

None.

The authors declare that there is no conflict of interest regarding the publication of this case report.

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