Spontaneous regression of cystic dysplasia of the rete testis in an 18-month-old boy: the key role of ultrasonography
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CASE REPORT
Spontaneous regression of cystic dysplasia of the rete testis in an 18‑month‑old boy: the key role of ultrasonography Giada Pizzuti1 · Dacia Di Renzo1 · Antonello Persico1 · Pierluigi Lelli Chiesa1 Received: 26 March 2019 / Accepted: 29 May 2019 © Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2019
Abstract Cystic dysplasia of the rete testis (CDT) is a rare cause of scrotal swelling in children. It is a congenital disorder and it can be associated with other genitourinary abnormalities. At present, there is no clear consensus on treatment. Surgical approach has traditionally been the treatment of choice, while, more recently, conservative approach has been applied, justified by the benign nature of the lesion and after few cases of spontaneous regression have been documented. Ultrasonography, supported by negative tumor markers, plays a key role in the diagnostic work up and during observational follow-up. We report a further case of spontaneous regression of suspected CDT in an 18-month-old boy, who has been followed with clinic and ultrasonographic checks. Keywords Cystic dysplasia · Rete testis · Ultrasound · Non-operative management · Regression
Introduction
Case report
Cystic dysplasia of the rete testis (CDT) is a rare cause of scrotal swelling in children. It is characterized by irregular cystic spaces in the mediastinum or rete testis [1]. It is often associated to ipsilateral genitourinary anomalies, most commonly renal agenesis. CDT still represents a challenging condition, since its natural course is not fully known because studies with longterm follow-up are lacking [2, 3]. It has been traditionally treated with radical orchiectomy, while, more recently, conservative approach has been applied, justified by the benign nature of the lesion. Testis-sparing surgery has been reported and, in a few reports, “wait and see” approach has been conducted, after some cases of spontaneous regression have been documented [4]. However, follow-up beyond puberty is still lacking. We report a case of spontaneous regression of suspected CDT in an 18-month-old boy, followed with observational management. The key role of ultrasonography (US) is discussed.
An 18-month-old boy was referred to our institution because of painless swelling of the left hemiscrotum. His prior medical history was unremarkable. Physical examination revealed an enlarged left testicle, with no induration or erythema. Right testicle was normal. US was performed and a well-circumscribed multicystic mass was observed in the left testicular parenchyma, in the mediastinum testis area. The lesion measured 15 × 10 × 8 mm and presented a slight vascularity at Doppler examination. The residual testicular parenchyma was compressed peripherally and was otherwise normal in echotexture (Fig. 1). Contralateral testis was normal. According to ultrasonographic characteristics, CDT was suspected. Screening for associated urinary anomalies was performed with an abdominal US, which was normal. Testicular tumor markers were negative
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