An unusual mass arising from the vas deferensaturation

Asian J Androl 2002 Sep; 4: 236

An 18-year-old man presented with a history of right-sided abdominal pain and weight loss. Clinical examination revealed the presence of a right-sided abdominal mass arising from the pelvis. Baseline haematological and biochemical investigations were normal. A computerized tomography scan revealed a 78?6 mm cystic mass indenting the right posterolateral aspect of the bladder. The right kidney was absent with a congenital anomaly and duplication of the inferior vena cava below the left renal vein. A dimercaptosuccinic acid (DMSA) scan revealed a large single kidney on the left. The diagnosis of a non-functioning symptomatic cystic dysplastic right kidney was made and operative intervention was under-taken.

At cystoscopy a cystic mass indenting the right side of the bladder was seen. Through a lower abdominal incision a cystic structure was found in the right hemipelvis, attached to the bladder, vas deferens and seminal vesicle. The mass was dissected free of its attachments and excised with a length of vas deferens. The patient made a good postoperative recovery.

Histology revealed fibromuscular connective tissue with surface urothelium and multiple cysts lined with mucin secreting epithelium. No recognisable renal parenchyma was seen and there was no evidence of neoplasia. A diagnosis of a benign primary lesion arising from the vas deferens was made.

Primary pathological conditions of the vas deferens are very rare. These include sperm granulomas [1] and vastitis nodosa [2]. Previous vasectomy and trauma are cited as aetiological factors [3]. This case showed neither the clinical history nor the histological features of these conditions. We think that this mass is a result of a congenital malformation of the vas causing obstruction and proximal accumulation of secretions. There is one previous report in the literature of a mass arising from the vas deferens in a 52-year-old male that was felt to be due to obstruction [4].

Figure 1. Pelvic CT scan showing the cystic mass closely related to the right posterolateral aspect of the bladder.

References  

[1] Silber SJ. Sperm granulomas and reversibility of vasectomy. Lancet 1977; 2: 588-9.
[2] Freund MJ, Weidmann JE, Goldstein M. Microrecanalization after vasectomy in man. J Androl 1989; 10: 120-32.
[3] Golstein M. Surgical management of male infertility and other scrotal disorders. In: Walsh P C, Retik AB, Dararcott Vaughan E, Wein AJ, eds. Campbell's Urology ( Seventh Edition) 1998; p 1343-4.
[4] Orrell JM. Unusual nodule arising from the vas deferens. BJU 1992; 70: 571-2.

home

Correspondence to: Mr. A.Haq, Penn Vale, 8 Albany Road, Bedford, MK40 3PH, UK.
Fax: +44-1473- 702 373
E-mail: a.haq@doctors.org.uk
Received 2002-03-18      Accepted 2002-05-29