Tubular Ectasia of the Rete Testis: What Is Behind It?

Abstract

Background: Tubular ectasia of the rete testis (TERT) is a dilatation of the seminiferous tubules of the mediastinum testis. It tends to be asymptomatic and usually constitutes an incidental finding of imaging studies. Scrotal ultrasound (SU) shows tubules with a cystic appearance, suggesting a number of possible diagnoses, including testicular tumours. Objective: To review our experience and describe the clinical and ultrasound features. Design: Retrospective descriptive review. Setting: The images were obtained by SU on an ambulatory basis. SU was performed with the Pro Focus Ultrasound System (BK Medical®, Massachusetts, USA). The indications of the exploration, the SU findings, and the associated conditions were the variables analysed. Participants: 460 SU studies performed in our hospital between 2010 and 2013. The subjects were men, with a median age of 66 years (range 47–78). Outcome Measurements and Statistical Analysis: SPSS® version 20 (IBM, New York, USA) was used for the descriptive analysis of the data. Results and Limitations: TERT was identified in 23 out of 460 SU studies performed. SU was indicated due to the presence of scrotal swelling in 7 patients (30%), an epididymal mass in 8 patients (35%), mild testicular pain in 6 patients (26%), and post-surgical control in 2 asymptomatic patients. Within the 23 patients, 10 (43.4%) were diagnosed with an epididymal cyst, 3 (13%) with chronic epididymitis, and 9 (39%) with a hydrocoele. With regard to associated conditions, 3 (13%) had undergone ipsilateral inguinal hernia repair, 3 (13%) had undergone ipsilateral hydrocoelectomy, and 1 (4%) had a history of contralateral testicular cancer. TERT was unilateral in all cases. No malignant degeneration of the lesions was observed in our series. Conclusions: According to our experience, TERT is an incidental condition where detailed clinical history, adequate physical examination, and SU findings can lead to the diagnosis. Knowledge of this disease is therefore essential for urologists. Patient summary: In this report we analyse the clinical features and the SU findings associated with TERT, a condition incidentally found in imaging studies of men in their 60s usually performed for other reasons.

Tubular ectasia of the rete testis: A benign yet unrecognized condition

“…TERT manifests as multiple cysts within the rete testis, attributed to obstruction or compression. 4 Its benign nature was confirmed through case evaluations. It's an acquired condition whose exact cause remains uncertain but, many potential factors are to discuss.…”

“…Surgical procedures like hernioplasty or vasectomy, congenital abnormalities like cryptorchidism, and conditions such as spermatocele or chronic epididymitis are associated with TERT. 4 …”

“… 3 Androgen deficiency contributes to epididymal duct atrophy. Additionally, systemic factors such as cirrhosis and calcium oxalate crystal accumulation in the tubular lumen among dialysis patients may induce this condition 3 , 4 …”

“…Although malignant transformation of the rete testis is rare, it has been acknowledged to be possible. 4 …”

“…Additional tests like serum HCG, α-FP, and LDH may aid diagnosis, with MRI and surgical exploration for confirmation. 3 , 4 , 5 …”