SEMINAL VESICLE CYST PRESENTING WITH LOWER URINARY TRACT SYMPTOMS AND HUGE ABDOMINAL MASS

Abstract

A 22-year-old man presented with urinary frequency, nocturia, dribbling, reduced force of urinary stream, an episode of acute urinary retention, and progressive constipation and abdominal mass 1 month in duration. Physical examination revealed an abdominal mass in the right suprapubic region without tenderness and mobility. Routine blood and urinary laboratory studies were normal. Sonography showed a solid hypoechoic, well-defined and homogeneous tumor between the bladder and rectum. There was no evidence of a right kidney. Films of the kidneys, ureters and bladder revealed increased pelvic density and spina bifida. Excretory urography demonstrated compensatory hypertrophy of the left kidney and mild left ureteral dilatation. The right kidney was not visible and the bladder was displaced with reduced volume (fig. 1). Transrectal ultrasonography showed a solid 132 3103 3 97 mm. mass in the pelvis presumed to be prostatic rhabdomyosarcoma. Casoni’s intradermal test and a hemagglutination inhibition test for hydatid cyst were negative. Abdominopelvic computerized tomography revealed a huge cystic mass with fine septations extending from the pelvic floor area, causing an indentation on the prostate and pushing the bladder anteriorly. Other organs were normal (fig. 2). On cystourethroscopy the urethra was visible and normal to the verumontanum but because of anterior displacement and elevation of the bladder neck, rigid cystoscopy was impossible. Retrograde cystourethrography showed a normal anterior urethra but the posterior urethra was elongated, compressed and distorted anteriorly, and the bladder was displaced. At surgical exploration there was a thick walled cystic lesion in the posterior retroperitoneum, adhering to the bladder and to both vas deferens, which was excised. The origin of cyst was the right seminal vesicle. The cyst contained homogeneous and brownish liquid. Histologically, the fluid had high protein content, and cytology showed red blood cells, lymphocytes, histiocytes and neutrophils. On pathological examination there was a fibrotic capsule with muscular and nerve fibers with no evidence of malignancy and no definite epithelial lining. The origin was probably the bladder or seminal vesicle. The patient was well when discharged home and had normal voiding function. DISCUSSION