Pathology for Urologists
- Results from accumulation of serous fluid between parietal and visceral tunica vaginalis of the testis.
- Congenital hydrocele occurs when a patent processus vaginalis within the spermatic cord communicates with the peritoneal cavity.
- Prevalence of congenital hydrocele: 6% at birth and 1% in adulthood.
- Most cases are idiopathic but may be associated with trauma, inguinal hernia, epididymoorchitis, or tumors of the testicular/ paratesticular region.
- Possible causes may include excessive secretion within the testicular tunics by parietal mesothelial cells, decreased reabsorption, and congenital absence of the efferent lymphatics.
- Gross: translucent cyst filled with clear or serous fluid (unless there has been trauma or secondary infection).
- Hydrocele is lined by a single layer of cuboidal or flattened mesothelial cells, sometimes with prominent atypia.
- Underlying connective tissue stroma with or without fibrosis and chronic inflammation.
- In some cases progressive fibrosis narrows or obliterates the cyst lumen, creating adhesions and multiple cysts.
- Fluid should not contain sperm unless a spermatocele has ruptured into the hydrocele sac.