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asbryobvrz · Wysłany: Pią 21:02, 04 Mar 2011

Seminal vesicle cyst misdiagnosed as a huge pelvic mass

Block No change. B-ultrasonic examination showed the bladder, prostate, normal bladder before exploration and 9.5em × 7.8em round ball the size of the echo-free mass, wall smooth and complete,[link widoczny dla zalogowanych], through the posterior wall of the sound is good. CT scan showed the bladder and bowel crypt 8em × 10em see the size of a water sample oval low density, uniform wall finishing, CT values of 7 ~ 22Hu. Clinical diagnosis of pelvic masses. Preoperative transrectal needle out of the line mass brown liquid, confirmed the cystic mass. Epidural anesthesia in laparotomy. See bladder surgery in the retroperitoneal mass, the external probe connected to see the tumor and the vas deferens. Fully free from the neck mass,[link widoczny dla zalogowanych], because of the location of deep, can not peep and complete picture of the neck ligation,[link widoczny dla zalogowanych], drainage hose set. Pathological report: collagen connective tissue, wall covered with short columnar epithelial lymphocyte infiltration, and death of sperm containing bloody fluid. Pathologic Diagnosis: Congenital seminal vesicle cyst. 2 weeks after prostate digital rectal examination can reach the top of the right front of the rectum tough cystic tumor mass. B-ultrasonic examination showed once again visible 6.6em × 4.8em bladder wall hypoechoic size, contour rules, through the posterior wall of sound intensity. 2 Clinical features of seminal vesicle cysts 2.1 discussed in part by the fetal kidney duct stump embryo formation period, often associated with other urinary genital malformations. Clinical manifestations include blood, sperm and urethral bloody discharge, gross and microscopic hematuria, lower abdominal and lumbosacral pain, perineal and testicular discomfort. Large cysts can cause difficulty urinating, urinary frequency, urgency, dysuria, and pyuria, seminal vesicle cyst, or caused a major cause of infertility. 2.2 The main points of the seminal vesicle cyst diagnosis based on blood, sperm, etc. In addition to the clinical symptoms, should also refer to other signs, test results and medical technology. Digital rectal examination in prostate cyst above the edge of the smooth and complete, flexible. Cystic fluid containing the sperm test. Vas deferens, seminal vesicle angiography is a reliable method of diagnosis of the disease, the rectum and perineum direct injection of contrast agent imaging is more practical, intravenous contrast medium excretion of urinary congenital anomalies can be understood, can help diagnosis. Besides the seminal vesicle cyst with mullerian duct cyst should be, prostate cyst, posterior urethral oval cyst, seminal vesicles, cancer and other diseases identified. Misdiagnosis of seminal vesicle cysts 2.3 is less common, although the trend of advanced inspection means 13, but due to lack of clinical experience, is difficult to avoid misdiagnosis. In this case frequency, urgency, dysuria, urinary pain with hematuria, prostate digital rectal examination between the top of a huge cyst rectal bladder, the urinary system diseases should be considered, but lack of experience, gave up dysuria and hematuria, and other important symptoms that,[link widoczny dla zalogowanych], according to Ultrasound and CT diagnosed as bladder and bowel crypt cysts, despite the preoperative cyst puncture confirmed the existence, but did not puncture routine examination, a history of pathological asked that after the return of infertility, azoospermia. This shows the lack of clinical awareness of this disease, history taking is unknown, omission of important history, let the main clinical symptoms, over-reliance on medical technology examination, routine examination without the necessary line is the main reason for misdiagnosis. 2.4 The treatment of seminal vesicle cyst is small, the practical massage seminal vesicle, cyst aspiration, larger cyst, cyst excision is the best cure, but surgical treatment is extremely important. The perineal operation can easily cause impotence, outside the channels suprapubic bladder and urethra easily hurt, easily formed after sacrococcygeal sacrococcygeal pain pathway, longitudinal incision through the bladder at the bottom of the bladder is not completely revealed seminal vesicle. Such as the bladder Road, bilateral ureter ureteral catheter marker set in the bilateral ureter bladder base below the transverse incision, clearly shows that the rectum and bilateral seminal vesicle. Abdominal surgery to take this case, although the removal of convenience, Vice damage, but can not cut deep to the cyst location and explore the vas deferens opening into the contralateral seminal vesicle,[link widoczny dla zalogowanych], after digital rectal examination and ultrasound showed bladder mass, does not rule out contralateral seminal vesicle cyst and residual cyst excision may be the side. Therefore, preoperative diagnosis should be sought in order to select the appropriate surgical procedures.