US of the Tunica Vaginalis Testis: Anatomic Relationships and Pathologic Conditions

Abstract

Extratesticular lesions are common incidental findings at ultrasonography (US) among men and boys. Most lesions originate from or depend on the tunica vaginalis, a mesothelium-lined sac with a visceral layer and a parietal layer. The tunica vaginalis is formed when the superior portion of the processus vaginalis closes during embryologic development. Abnormal closure of the processus vaginalis leads to congenital anomalies of the tunica vaginalis, such as complete or partial patency of the processus vaginalis, spermatic cord hydrocele, and inguinoscrotal hernia. The proximity of the visceral layer to the testis explains the reactive involvement seen in epididymo-orchitis, with resultant pyocele or abscess formation. The tunica vaginalis also may be affected by inflammatory and traumatic disorders such as scrotal calculi, fibrous pseudotumor, or hematocele. These lesions manifest as solid or heterogeneous tumorlike masses. Lesions of mesothelial origin, such as adenomatoid tumor, tunica cyst, and mesothelioma, may involve the tunica vaginalis. Entrapped mesenchymal cells can lead to lipoma, leiomyoma, or sarcoma, although these tumors are uncommon in the tunica vaginalis. US is not useful for differentiating between benign and malignant tumors; however, some characteristic findings may help in planning the best surgical approach. Knowledge of the embryologic development, anatomic relationships, and pathologic disorders of the tunica vaginalis is essential to narrow the differential diagnosis of an extratesticular lesion. In most cases, US findings in combination with clinical assessment can indicate whether nonsurgical management or testis-sparing surgery is warranted.

A Brief Review of Jorjani’s Views on Hernias

“…If the hernias extend through superficial inguinal ring, it is called complete inguinal hernia. In men, intestine enters the scrotum and so is called scrotal hernia, and if it does not extend through superficial inguinal ring, it is called incomplete inguinal hernia [18]. Zakhirah states the same procedure: There, it is mentioned that if the intestine does not descend lower than inguinal region, it is called incomplete inguinal hernia and if the intestine reaches the scrotum, it is scrotal or complete inguinal hernia (Z).…”

Imaging features of a huge spermatic cord leiomyosarcoma: Review of the literature

“…Apart from purely cystic extratesticular lesions (epididymal cyst, scrotal tunica cyst) most of the solid lesions, either benign (adenoid tumor, papillary epididymal cystadenoma, fibrous pseudotumor, inguinoscrotal hernia, lipoma, leiomyoma) or malignant (rhabdomyosarcoma, liposarcoma, leiomyosarcoma, mesothelioma), frequently have overlapping characteristics, making it extremely difficult to exclude malignancy [18,19] . Considering the above imaging features the mass was more compatible with a leiomyosarcoma (exclusion of rhabdomyosarcoma due to the age of the patient), even though the diagnosis of a benign leiomyoma or a fibrous pseudotumor could not be completely excluded [18][19][20] .…”

Cystic lesions and scrotal fluid collections in adults: Ultrasound findings

“…Hydrocele is a more or less abundant fluid collection between the two layers of the tunica vaginalis with possible dorsal displacement of the didymus and epididymis [29]. Hydrocele is primitive when it is caused by an abnormal reabsorption of the fluid which is normally present in the tunica vaginalis, whereas it is secondary when it is the result of inflammation, trauma or tumors.…”