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THE RISK FACTORS OF THE EPIDIDYMAL CYST

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  • On 26/04/2020
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The epididymis (from the Greek epididymis) is an organ belonging to the male reproductive system located at the level of the wall of the testis.

The cyst of the epididymis or also called the testicular cyst or spermatocele. Grows at the expense of the swollen part of the upper part or head of the epididymis. There may be one or more cysts within the same epididymis. The cyst of the epididymis is a pathology that can occur at any age. The epididymis is located at the level of the testicular wall, this structure is essential for the maturation and transport of sperm. Relatively frequent, these cysts are sometimes very painful and require intervention.

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Anatomy

Position. There are two epididymides. Each epididymis borders the upper and posterior surface of each testis.

Structure. The epididymis is made up of a retracted tube, called the epididymal canal, measuring on average six meters in length. It is made up of three parts:

The head of the epididymis which originates on the upper part of the testis;

The body of the epididymis which is the intermediate part extending on the dorsal face of the testicle;

The tail of the epididymis which constitutes the last part extending through the vas deferens.


Envelope:

. The epididymis and testis are contained in the scrotum, the wall of which forms the tunica vagina.

Attachment points. The epididymis is connected to the testis by the upper and lower epididymal ligaments.

Vascularization. The epididymis is supplied by the testicular arteries.

Sperm production

Maturation of sperm. Spermatogenesis takes place within the testis. Then the sperm is collected within the epididymis where they complete their maturation.

Storage and routing of sperm. Sperm is stored mainly at the tail of the epididymis but also the level of the body. Contractions of the muscular wall of the epididymis will allow the sperm to flow to the vas deferens.

Protection of the epididymis. The epididymis and testis are protected from shock by the scrotum.

Pathologies associated with the epididymis

Epididymitis. This pathology corresponds to inflammation of the epididymis. It is often associated with another inflammation in the prostate or urethra. This inflammation may be due to a bacterial infection. It manifests itself by feverish rises, redness, swelling and sharp pain in the testicles.

Cyst of the epididymis. A cyst is a cavity filled with fluid that can develop especially in the head of the epididymis. The development of a cyst can cause discomfort and pain in the testicles.

Testicular cancer. Malignant tumors can develop in the testis and epididymis. These tumors can remain silent for a long time without causing particular pain. They are most often revealed by palpation by noting the presence of a hard mass.

Risk factors

a) Ethnic and socioeconomic factors  :

Several studies have shown the impact of these factors in the occurrence of MIT, without showing the causal link. A predominance in black men and subjects of a low socioeconomic level has been observed.

 b) Genetic factors  :

 Several genes are implicated in the occurrence of MIT: + Nonsense mutation of the Phosphodiesterase 11A (PDE11A) gene which encodes a protein that plays a role in regulating the intracellular concentration of cAMP and cGMP. [34] + other mutations in other genes have been identified including the mutation of the SLC34A2 and GALNT3 gene, both encoding a protein involved in the transport and metabolism of phosphate.

CIRCUMSTANCES OF DISCOVERY

- The most common dominant symptom of testicular cysts is painless swelling of the testis; 30 to 40% of patients complain of a dull pain radiating to the groin, perineum or scrotum. Sharp pain is rare in testicular tumors. In the presence of epididymitis or orchid-epididymitis, close control is imperative. The hard mass in full parenchyma represents the typical form, it is readily insensible or not very painful. - A large purse; whose scrotal contents are not dissociable. - “Acute bursae” associate pain with inflammatory signs; they represent the most common differential diagnosis of malignant testicular tumors. - The flat and empty bursa associated with abdominal pain and alteration of the general condition or with gynecomastia should suggest the possibility of a tumor of the testicle in an ectopic position. - Lumbar pain is found in 10% of patients and is readily associated with abdominal pain, anorexia, they are the witness of retroperitoneal lymphadenopathy. - Gynecomastia is found in 5 to 10% of cases and should seek a testicular tumor. - The discovery can be accidental during a sterility assessment or by simple palpation of the external genitalia (toilet, sexual partner). -The pulmonary metastases discovered by cough, dyspnea, or hemoptysis represent a rare circumstance, they are readily the witness of tumor having a choriocarcinomatous contingent. - Lumbar pain is found in 10% of patients and is readily associated with abdominal pain, anorexia, they are the witness of retroperitoneal lymphadenopathy. - Gynecomastia is found in 5 to 10% of cases and should seek a testicular tumor. - The discovery can be accidental during a sterility assessment or by simple palpation of the external genitalia (toilet, sexual partner). -The pulmonary metastases discovered by cough, dyspnea or hemoptysis represent a rare circumstance, they are readily the witness of the tumor having a choriocarcinomatous contingent. - Lumbar pain is found in 10% of patients and is readily associated with abdominal pain, anorexia, they are the witness of retroperitoneal lymphadenopathy. - Gynecomastia is found in 5 to 10% of cases and should seek a testicular tumor. - The discovery can be accidental during a sterility assessment or by simple palpation of the external genitalia (toilet, sexual partner). -The pulmonary metastases discovered by cough, dyspnea or hemoptysis represent a rare circumstance, they are readily the witness of tumor having a choriocarcinomatous contingent. - Gynecomastia is found in 5 to 10% of cases and should seek a testicular tumor. - The discovery can be accidental during a sterility assessment or by simple palpation of the external genitalia (toilet, sexual partner). -The pulmonary metastases discovered by cough, dyspnea or hemoptysis represent a rare circumstance, they are readily the witness of tumor having a choriocarcinomatous contingent. - Gynecomastia is found in 5 to 10% of cases and should seek a testicular tumor. - The discovery can be accidental during a sterility assessment or by simple palpation of the external genitalia (toilet, sexual partner). -The pulmonary metastases discovered by cough, dyspnea or hemoptysis represent a rare circumstance, they are readily the witness of tumor having a choriocarcinomatous contingent.

The factors that increase the risk of testicular cysts vary due to the various causes of testicular abnormalities. History of testicular cancer or contralateral intratubular germinal neoplasia.

The presence of a gonadal dysgenesis syndrome associating more or less:

a history of cryptorchidism (homo- or contralateral). Present in almost 10% of cases, it multiplies the risk of cancer by 5 to 10 times depending on the age and date of treatment. Surgical testicular lowering, if it does not reduce the risk of cancer, has the advantage of facilitating testicular palpation;

· Testicular atrophy;

A hypospade;

- fertility problems.

- Klinefelter syndrome.

Infertility.

First-degree family history.

Other contributing factors are discussed such as certain environmental factors such as estrogen intake by the mother during pregnancy, exposure to certain substances from the chemical industry, or to certain substances present in the environment (insecticides, herbicides ).

Acute atypical scholarship  :

 The problem arises in a young man with an acute painful bursa, but without the clinical signs characteristic of spermatic cord torsion or orchi-epididymitis. This is the problem of the differential diagnosis with a germ cell tumor with acute revelation (about 10% of testicular tumors).

Important risk factors include:

Undescended or retractile testis

An undescended testicle does not leave the abdomen and enter the scrotum during fetal development or infancy. A retractile testicle descends into the scrotum but retreats into the abdomen. Either could increase the risk of:

Inguinal hernia

Testicular torsion

Testicular cancer

Abnormalities present at birth

Abnormalities of the testes, penis, or kidneys present at birth (congenital) could increase the risk of a scrotal mass and testicular cancer later in life.

PHYSICAL EXAMINATION

- In the typical form: Palpation finds a hard irregular testicular swelling deforming the testicle, insensitive or not very painful on palpation. The tumor is separated from the epididymis by the interepididymotesticular groove (Chevassu's sign). It may be a heavy, large tumor or a hard testicular nodule that may mistakenly suggest an epididymal nucleus. The tumor is opaque to transillumination. Any testicular lesion is considered malignant until proven otherwise.

Tumor testis can present several aspects:

- When the tumor is localized to the testicle, the cord and scrotal envelopes are normal. The epididymis is perceived, running over the testicular surface (sign of chevassu). Thus any hard intra-testicular mass, sometimes irregular, and modifying the consistency of the testicle must be considered as a testicular tumor until proven otherwise. This tumor should be palpated gently so as not to increase the

 
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