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An 18-month-old Angus bull presented to Auburn University College of Veterinary Medicine for a routine breeding soundness evaluation and lameness evaluation. He was classified as deferred potential breeder due to a lameness and was donated to the university. Following treatment, the bull's lameness resolved. He passed the breeding soundness examination in accordance with the Society for Theriogenology standards. However, avascular dilated areas at the level of the mediastinum testis of the right testicle were detected via Doppler ultrasonography. A high level of vascularity is routinely seen with neoplasia, such as teratomas. Due to the lack of vascularity, a presumptive diagnosis of tubular ectasia of the rete testis was made. The bull was castrated. The right testicle was submitted for histopathology revealing a definitive diagnosis of tubular ectasia of the rete testis., (© 2021 Wiley-VCH GmbH.)

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.

Cystic dysplasia of the rete testis (CDT) is a rare, benign, cause of testicular mass in the pediatric population. The mass appears on sonography as multiple small cysts of varying size surrounded by normal or compressed testicular tissue. CDT is often associated with other genitourinary anomalies, commonly presenting with agenesis or dysplasia of the ipsilateral kidney. The pathophysiology and the management remains controversial. We report a case of a 3-year-old presenting with an enlarged testicular mass later presumed to be CDT associated with ipsilateral renal agenesis, review the literature, and propose an evaluation and management algorithm., (Copyright © 2020 Elsevier Inc. All rights reserved.)

The ultrasound scan plays an essential role in the urological-andrological diagnosis. High-resolution transducers (8-15 MHz) make it possible to prove increasingly small changes. The assessment of cystic masses in the testis can also be difficult for experienced doctors. However, a precise diagnosis is crucial for the patient to avoid further invasive diagnostics and therapy. The differential diagnosis of benign intra-testicular cystic lesions include the tubular ectasia of the rete testis (TERT), the cystic dysplasia, epidermoid cysts, dermoid cysts, simple testicular cysts and cysts of the tunica albuginea. Malign testicular tumours with cystic changes are particularly the mature teratoma, carcinomas of the epididymis and metastasis. The following overview shows different sonographic images and interpretations with a particular focus on TERT.

Sertoliform cystadenoma of the rete testis represents an uncommon benign tumour. They appear in patients from 26 to 62 years of age. We describe a case of a 66-year-old man with a tumour in the area of the epididymal head. The tumour markers were not increased. Under the assumption of a malignant testicular tumour an inguinal orchiectomy was performed. The cut surface of this tumour was of grey/white color and showed small cysts. The tumour consisted of two compartments. The epithelial like tumour cells showed a sertoliform growth pattern and cystic dilatations. In between the tumour cells repeatedly actin expressing sclerotic areas could be recognized as the second tumour component. Proliferative activity was not increased. Immunohistochemically the tumour cells were positiv for inhibin, S-100, and CD 99. Alpha feto protein (AFP), human chorionic gonadotropin (ß-HCG) and placental alkaline phosphatase (PLAP) as well as synaptophysin, epithelial membrane antigene (EMA), and BCL-2 were not expressed. As far as we know this is the sixth reported case of this tumour. Because of the benign nature of this tumour the correct diagnosis is important for the intra- and postoperative management. Here we present a case of this rare tumour and discuss potential differential diagnosis., Virtual Slides: The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1956026143857335.

Objective: To explore the correlation between ectasia of the rete testis (ERT) and the volume of seminal vesicle cyst (SVC) in the epididymal head by ultrasonography., Methods: This study included 36 cases of ERT diagnosed by color Doppler ultrasonography and complicated with SVC in the epididymal head (case group), and another 44 SVC cases without ERT (control group), all confirmed by surgery or fine-needle aspiration. We analyzed the differences in nationality, age, volume of SVC and resistance index of the afferent artery in the diseased testis between the two groups of patients., Results: No statistically significant differences were observed between Chinese Uighurs and Hans (P > 0.05), nor in the mean age between the two groups of patients (P > 0.05). There were significant differences in the mean volume of SVC between the case and control groups ([2.081 +/- 1.147] cm3 vs [1.009 +/- 0.848 ] cm3, P < 0.01), but not in the resistance index of the afferent artery in the diseased testis (0.644 +/- 0.099 vs 0.608 +/- 0.116, P > 0.05)., Conclusion: The volume of seminal vesicle cyst in the epididymal head plays a significant role in the formation of ectasia of the rete testis.

We describe the rare combination of testicular microlithiasis, unilateral intra/extratesticular varicocele, and tubular ectasia of the rete testis in a 17-year-old boy who presented with testicular pain following a trauma. He had a prior history of undescended testis and orchiopexy in childhood. His workup included a normal abdominal ultrasound and a sperm analysis demonstrating a low sperm count with sperm dysmotility. A follow-up ultrasound was unchanged, and he has been managed conservatively. This combined set of findings has not been previously reported., (Copyright © 2011 Wiley Periodicals, Inc.)

Cystic dysplasia of the testis is a rare congenital anomaly. It presents a diagnostic challenge to the pediatrician and should be distinguished from malignant lesions. We herewith present a two-month-old boy who presented with right inguinal swelling. Detailed investigations including ultrasound and magnetic resonance imaging helped in establishing the diagnosis of cystic dysplasia. To the best of our knowledge, our case is the first case of cystic dysplasia of the rete testis in the literature, which presented as undescended testis (inguinal swelling), with no associated renal or ureteric anomalies.

The use of high-frequency ultrasound is increasing for the treatment of cystic, vascular, and solid non-neoplastic intratesticular masses. Cystic lesions examined include simple testicular cysts, tunica albuginea cysts, epidermoid cysts, tubular ectasia of rete testis, and intratesticular abscesses. Vascular lesions examined include intratesticular varicocele and intratesticular arteriovenous malformations. Solid lesions examined include fibrous pseudotumor of the testis, focal or segmental testicular infarct, fibrosis of the testis, testicular hematoma, congenital testicular adrenal rests, tuberculoma, and sarcoidosis. Gray-scale and color-flow Doppler sonography facilitate the visualization of the benign characteristics of the lesions. Magnetic resonance imaging can also help as a problem-solving modality in some cases.

Background: Tubular ectasia of the rete testis (TERT) sonographically consists of a cluster of anechoic foci located at the mediastinum testis. TERT is important diagnostically, because it might be confused with malignant teratoma that may likewise contain cystic areas., Patients and Methods: Twenty-four patients with TERT were identified sonographically. Ten of these patients underwent additional magnetic resonance imaging (1.5 T), and three had contrast-enhanced scrotal sonography. A descriptive analysis was done regarding clinical details and sizes of the single anechoic foci and of the entire areas involved with cystic changes., Results: The median age of the patients with TERT was 60 years. Diagnosis was based on incidental findings or uncharacteristic symptoms in three quarters of the cases. The size of the single cysts was ≤ 3 mm, 4-6 mm and ≥ 7 mm in 12, 6 and 6 patients, respectively. The size of the entire area involved with cystic changes ranged from 0.5 x 1.2 cm to 2.5 x 3.0 cm. Six patients had TERT bilaterally, and 18 had concomitant spermatoceles. T2-weighted MRI demonstrated high signal intensity of the cystic areas. No signal enhancement was found in these areas after application of contrast agent. Contrast-enhanced sonography did not show uptake in the TERT areas. Histological evidence for dilatation of the rete testis was found in the two patients undergoing diagnostic surgery., Conclusions: TERT is a benign lesion of the testis that is increasingly detected sonographically. Knowledge of TERT is essential for the urologic sonographer to avoid unwarranted diagnostics and surgery as well as costs.

Tubular ectasia of the rete testis (TERT) is a rare benign condition of the testis due to dilatation of the tubules of the rete testis. It must be differentiated from neoplastic disease of the testis clinically by patient's age, mode of presentation, tumour marker status and characteristic ultrasound and colour Doppler findings. Awareness and diagnosis of TERT should prevent unnecessary surgical intervention such as orchidectomy or biopsy. We report a case of severe bilateral tubular ectasia of the rete testis associated with azoospermia and review the relevant literature. This association has not been reported before in the literature to the best of our knowledge.

Cystic dilatation of the rete testis, often also known as cystic ectasia of the rete testis, is a poorly understood condition that may be a cause of male infertility. This study examined the frequency of this condition in 749 men attending an infertility clinic with their partners. Of these 749 men, semen analysis was abnormal in 275 (37%) but apparently normal in 474 (63%). All the men attending the infertility clinic underwent a testicular ultrasound. Of these 749 men, the lesion was present in nine (1.2%); it was present bilaterally in three and unilaterally in six. In two men, one of whom had a bilateral lesion, the sperm count was normal. It is unclear whether this lesion is a cause of infertility but it is important that this condition is diagnosed so that its prevalence and its relationship to infertility can be ascertained.

Ultrasound is the preferred technique when imaging the scrotal contents. Although appearances of many of the more common abnormalities present the examiner with no diagnostic difficulty, the more unusual conditions may present a considerable challenge. Many normal variants, unusual and rare abnormalities may be instantly recognized once seen. The current review highlights the more unusual and rare conditions affecting the scrotal contents in order to allow the reader the opportunity to gain knowledge of their existence and to aid future interpretation of the difficult examination.

Objectives: The cystic ectasia of the rete testis is a benign entity with a typical ultrasound appearance as a collection of small hypoechoic structures in the confluence of the mediastinum testis. The clinical importance of these entity remains on doing an adequate differential diagnosis with testicular neoplasias with a cystic component., Methods: We retrospectively reviewed the database of the Ultrasound Unit in the Department of Urology looking for patients with a diagnosis of cystic ectasia of the rete testis over a six-year period., Results: Three cases of cystic ectasia of the rete testis were diagnosed over the six-year period, in all the indication for ultrasound was testicular pain. Mean patient age was 62 years. No patient developed testicular tumor on follow-up., Conclusions: The knowledge of the ultrasound characteristics found in the cystic ectasia of the rete testis helps to make a proper diagnosis of this benign entity without the need of indication of testicular biopsy.

Objective: To diagnose tubular ectasia of the rete testis with color flow Doppler imaging., Methods: Sonographic, CDFI and pulse wave Doppler appearance in tubular ectasia of the rete testis was described., Results: The characteristic ultrasound appearance with no associated soft-tissue abnormality and no flow on color flow Doppler imaging was seen., Conclusion: Color Doppler ultrasound imaging is the first choice for the diagnosis of tubular ectasia of the rete testis.

Cystic dysplasia of the rete testis is a rare abnormality often associated with the ipsilateral agenesis of kidney. This malformation is due to a development defect of the mesonephric duct which is the cause of both the dilation of the testicular rete testis and renal agenesis. A case of this rare malformation, showing all the peculiarities described in the medical literature, is presented. A 3 years-4 months boy was examined for an asymptomatic left scrotal mass; thus, he underwent ultrasonography, which showed a multiple tubular and cystic dilatation of left rete testis, associated with the absence of left kidney, afterward confirmed by MAG3-radionuclide scan. Diagnosis was also validated by testicular biopsy. No surgery was required. The child is nowadays under observation and at 2-years follow-up he doesn't show any symptom. According to many authors, a conservative treatment of this benign congenital abnormality is suggested as well as serial ultrasonography to monitor the growth of the testicular mass, which in a longest follow-up, could require surgery. Malignant transformation nor infertility have never been described.

We report a case of adenocarcinoma of the rete testis in a 44-year-old man, presented intially with a hydrocele and later with signs of infection in the affected hemiscrotum. Multiple focal lesions within the testis appeared 6 months later in ultrasounds. After high inguinal orchiectomy, histology revealed a primary adenocarcinoma of the rete testis. Adenocarcinoma of the rete testis is a rare a highly malignant tumour originating in the mediastinum of the testis. Slightly over 40 cases have been reported in the literature. The treatment of choice is radical orchiectomy. Prognosis is poor; as mainly as 40% of patients die within the first year of diagnosis.

Purpose: Cystic ectasia of the rete testis is a rare condition that may be incidentally noted on scrotal ultrasonography. This benign condition has a typical appearance of a collection of small anechoic structures in the confluence of the mediastinum testis. The main significance of this condition is that it must be differentiated from testicular neoplasm. We reviewed the experience with this condition at our institution., Materials and Methods: A retrospective review was performed to identify all sonograms showing ectatic rete testis performed from 1998 through February 2002. A departmental database was used to identify all scrotal sonograms from this period showing ectasia of the rete testis and clinical correlation was done. These examinations were then reviewed by a single radiologist., Results: We identified 13 cases in the last 4 years. Ultrasound was most commonly performed for a testicular or scrotal mass, or pain. Median patient age was 65 years. All except 1 patient had an underlying condition, including vasectomy, epididymal cyst/spermatocele or inguinal hernia repair, that could cause epididymal or efferent duct obstruction. No patient had a solid testicular mass., Conclusions: Based on clinical and sonographic criteria the diagnosis of cystic ectasia of the rete testis can be made without histological confirmation. Identifying this entity and its associated conditions avoids the need for biopsy or orchiectomy.

Spermatogonial stem cells form the foundation of spermatogenesis, and their transplantation provides a unique opportunity to study spermatogenesis and may offer an alternative approach for animal transgenesis. This study was designed to extend the technique of spermatogonial transplantation to an economically important, large-animal model. Isolated immature pig testes were used to develop the intratesticular injection technique. Best results of intratubular germ cell transfer were obtained when a catheter was inserted into the rete testis under ultrasound guidance. The presence of infused dye or labeled cells was confirmed in the seminiferous tubules from 70 of 89 injected isolated testes. Infusion of 3-6 ml of dye solution or cell suspension could fill the rete and up to 50% of seminiferous tubules. The technique was subsequently applied in vivo. Donor cells included testis cells from 1- or 10-wk-old boars (from the recipients' contralateral testis or unrelated donors) and those from mice carrying a marker gene. Porcine testis cells were labeled with a fluorescent marker before transplantation. Testes were examined for the presence and localization of labeled donor cells immediately after transplantation or every week for 4 wk. Labeled porcine donor cells were found in numerous seminiferous tubules from 10 of 11 testes receiving pig cells. These results indicate that germ cell transplantation is feasible in immature pigs, and that porcine transplanted cells are retained in the recipient testis for at least 1 mo. This study represents a first step toward successful spermatogonial transplantation in a farm animal species.

The rete testis is formed in the fifth week of intra-uterine life. The epithelium along the medial side of the mesonephric ridge thickens to form a genital ridge; cellular gonadal cords at the periphery of the ridge unite with a tubular network from the mesonephric mesenchyme forming the testicular rete. On ultrasound, a range of normal appearances of the rete testis is recognised from ill-defined areas of decreased reflectivity to a coarse tubular appearance (often with finger like projections). In the present review the embryological development of the rete testis is briefly outlined. In addition, the important anatomical variations, pertinent to ultrasound imaging, will be presented.

Benign intratesticular lesions are rare, but recognition is important to avoid unnecessary surgical intervention. The ultrasonographic (US) features that help differentiate benign from malignant intratesticular lesions are emphasized by the authors. Benign lesions include intratesticular simple cysts, tubular ectasia, epidermoid cyst, tunica albuginea cyst, intratesticular varicocele, abscess, and hemorrhage (infarction). US features of cystic malignant neoplasms that help in differentiation of them from benign cystic lesions are also presented. The US appearance of epidermoid cysts varies with the maturation, compactness, and quantity of keratin present. Of the cystic malignant testicular tumors, which can occur anywhere in testicular parenchyma, teratomas are the most frequent to manifest as cystic masses. An abnormal rind of parenchyma with increased echogenicity usually surrounds these lesions. An intratesticular spermatocele communicates with the seminiferous tubules, whereas simple ectasia of the rete testis does not do so directly. These cysts contain spermatozoa and can be septate. The US findings of intratesticular varicocele are similar to those of extratesticular varicocele and include multiple anechoic, serpiginous, tubular structures of varying sizes. Improvements in gray-scale and Doppler US technology allow subtle distinctions between benign and malignant testicular lesions that were not possible a decade earlier.

Cystic dysplasia of the rete testis (the network of straight seminiferous tubules within the mediastinum testis leading to the efferent ductules) is a rare congenital anomaly. There are only 15 cases reported in the literature to date and only one report of the US findings [1-5]. This report highlights the characteristic appearance of the lesion on ultrasound examination and its association with renal abnormalities in two patients.

Objective: The sonographic findings and associated etiological conditions in 19 patients with tubular ectasia of the rete testis are described., Methods: 19 patients with tubular ectasia of the rete testis diagnosed by ultrasound over a two-year period are presented. Twenty-seven testes showed ectasia. The mean age at the time of diagnosis was 59 years. US evaluation was performed with the 7-8 MHz multifrequency linear probe (Acuson 128, Mountain View, CA, USA). The patients were evaluated in the supine position and the scrotal content was examined in the sagittal and transverse planes. A color and pulsed Doppler study were performed in all the cases., Results: 8 patients showed bilateral involvement, 7 had left and 4 right tubular ectasia. Other frequently associated findings were spermatocele (8 cases), cord cyst (6 cases) and varicocele (5 cases). Four patients had undergone scrotal surgery and one had a previous history of epididymitis., Conclusions: Tubular ectasia of the rete testis is an uncommon, benign condition that is usually associated with epididymal obstruction following trauma or infection in most of the cases. Diagnosis of tubular ectasia by US, in a correct clinical context, obviates the need to perform a biopsy and orchidectomy for its diagnosis in a vast majority of the cases.

Background: Cystic transformation of the rete testis is a little-known partial or complete obstruction of the spermatozoa-containing secretion of the head of the epididymis. Depending on its severity, either ectasia or a cystic transformation occurs, which spreads to the network of convoluted seminiferous tubules in the mediastinum testis. Findings in contrast-enhanced MRI examinations are characteristic and may help to differentiate this benign entity from malignant neoplasia. The authors present two pronounced cases in different stages, documenting the broad spectrum of possible involvement.

The aim of this study was to show the US findings in mode B and color Doppler duplex of the dilatation of the rete testis, in order to analyze its association with other scrotal processes and to confirm their inclusion into the benign testicular lesions. We present seven diagnosed cases (mean age 61 years) of dilatation of the rete testis to which a clinical control and US was accomplished up to 1 year. The scrotal sonography study was carried out with a linear probe of 7.5 Mhz. In the US examination we observed in all cases an intratesticular image located in the mediastinum testis constituted by anechoic and serpiginous tubular structures, which do not show any blood flow with the color Doppler. In one case the mentioned observations were bilateral. Five cases had cysts in epididymis and the last case showed an increase in size in the epididymis head. Color Doppler duplex examination did not detected flow dots in the seven patients. The dilatation of the rete testis is a benign entity frequently associated with pathology in epididymis, with specific US findings which permit avoidance of invasive tests.

Tubular ectasia of the rete testis (TERT) is a benign entity due to dilation of the tubules of the rete testis. Most of the time it is discovered incidentally on scrotal sonograms and may be misinterpreted as malignant. This article outlines the diagnostic criteria of TERT, its possible causes, its incidence and its potential evolution. Recognizing this entity owing to its characteristic clinical, sonographic and, if necessary, MRI features is important to avoid unnecessary surgery or biopsies.

Tubular ectasia of the rete testis is a recently recognized entity whose sonographic appearance has been described principally in the radiological literature. The sonographic features of this benign process must be appreciated by urologists as well so that is not mistaken for malignancy. We report 3 cases showing the spectrum of this process and review the literature.

Tubular ectasia of the rete testis is an uncommon entity that is usually discovered incidentally during ultrasound evaluation of epididymal abnormalities. The characteristic ultrasound appearance, its frequent association with spermatoceles and the lack of a palpable mass are the main features that permit identification of this entirely benign lesion.

Tubular ectasia of the seminiferous tubules of the rete testis is an uncommon benign condition which was only recently described. Its US pattern is typical and allows the disease to be distinguished from cystic tumors of the testicle. The condition was evaluated with US in 10 patients; all men were over 50 years old. US was performed with a 7.5-MHz linear probe. The lesion was unilateral in 7 and bilateral in 3 patients. It was always localized in the mediastinum testis and was associated with spermatocele in 5 cases and with testicular cysts in 4. On US scans, the condition presented with several tubular or rounded anechoic structures, mimicking a hypoechoic mass. In 5 men with 4-19 months' follow-up, no change in lesion size and structure was observed. Tubular ectasia was never assessed with biopsy or histology. Tubular ectasia of the rete testis shares several US features with testicular cysts and spermatocele, which are likely to have the same underlying mechanisms. This benign condition can be distinguished from true cysts and testicular tumors on the basis of US findings and its differential diagnosis is important to avoid unnecessary surgery.

Improved technology enables better visualization of normal anatomical structures. The rete testis is now visible as an ill-defined echo-poor region at the testicular hilum, sometimes with arboriform projections into the parenchyma. In a retrospective review of 100 cases of non-inflamed testes, the rete testis was seen in 18%. The anatomy was confirmed by scanning post-mortem specimens in a waterbath, marking the echo-poor region and then studying the histology. The spectrum of ultrasound appearances of the normal rete testis is presented. The rete testis can be distinguished easily from pathology because the parenchyma remains otherwise homogeneous and normal in appearance.

Eleven scrotal sonographic examinations showing a spectrum of findings within the mediastinum testis were collected over a 2 year period. Each case showed numerous small tubular or rounded anechoic structures within the mediastinum testis; often, the findings mimicked a hypoechoic mass. Findings were bilateral in eight of ten patients; one additional patient had only one testis because of orchiectomy. All patients had an associated extratesticular finding, in most cases a spermatocele. Tubular ectasia shares several features with testicular cysts and mechanisms of formation are postulated to be similar to those previously proposed for testicular cysts. Recognizing tubular ectasia is important to avoid unnecessary concern and potential surgery.

We reviewed the scrotal sonograms of 31 patients who had a testicular mass consisting of multiple small spherical or tubular anechoic structures in the region of the mediastinum testis. The median age of the patients was 62 years (range, 31-76 years). The abnormality was unilateral in 22 patients and bilateral in nine. Thirty-four (85%) of the 40 involved testicles had coexisting epididymal abnormalities: 32 with epididymal cysts and two with epididymitis. Follow-up sonograms were available in five patients and showed no change up to 4.5 years after the initial diagnosis. Surgical and histologic findings were available in one other patient and showed dilatation of the rete testis. The sonographic appearance and location of the lesions, the frequent presence of an epididymal abnormality, and the surgical and histologic findings in one case suggest that the lesion is due to dilatation of the rete testis, probably associated with obstruction in the epididymis. Recognition of this entity on sonograms may prevent unnecessary orchiectomy.