Tunica albuginea (TA) cysts are the most common extratesticular benign scrotal mass lesion. They are a type of scrotal tunica cyst.
Their mean age at presentation is 40 years (may be even be seen in the 5th and 6th decades).
They are usually palpable.
They arise from the tunica albuginea (TA), a fibrous layer below the tunica vaginalis which closely covers the testicle. The posterior surface of the TA extends into the interior of the testis, forming an incomplete septum known as the mediastinum testis. The exact pathogenesis of tunica albuginea cysts is not known but it is believed to be from the mesothelia.
They are characteristically located at the upper anterior or lateral aspect of the testicle.
Ultrasound is the first line modality for imaging and imaging investigation of choice.
- typically seen as an anechoic paratesticular cyst, usually ranging around 2-5 mm in diameter
- sharply demarcated
- unilocular or multilocular
- no solid components
- no disturbance of the adjacent testicular tissue
- may rarely calcify
- occasional milk of calcium or have a complex appearance
On ultrasound consider:
- 1. Alvarez DM, Bhatt S, Dogra VS. Sonographic spectrum of tunica albuginea cyst. J Clin Imaging Sci. 2011;1 (1): 5. doi:10.4103/2156-7514.73503 - Free text at pubmed - Pubmed citation
- 2. Dogra VS, Gottlieb RH, Rubens DJ et-al. Benign intratesticular cystic lesions: US features. Radiographics. 2001;21 Spec No (suppl_1): S273-81. doi:10.1148/radiographics.21.suppl_1.g01oc15s273 - Pubmed citation
- 3. Martínez-Berganza MT, Sarría L, Cozcolluela R et-al. Cysts of the tunica albuginea: sonographic appearance. AJR Am J Roentgenol. 1998;170 (1): 183-5. doi:10.2214/ajr.170.1.9423628 - Pubmed citation
- 4. Gittleman AM, Perlmutter S, Hutchinson A et-al. Milk of calcium in a tunica albuginea cyst. J Ultrasound Med. 2002;21 (6): 673-6. J Ultrasound Med (full text) - Pubmed citation
- 5. Poster RB, Spirt BA, Tamsen A et-al. Complex tunica albuginea cyst simulating an intratesticular lesion. Urol Radiol. 1991;13 (2): 129-32. Pubmed citation
- 6. Images in Urology. Springer. ISBN:0857297686. Read it at Google Books - Find it at Amazon
- 7. Redman JF, Rountree GA. Bilateral cysts of tunica albuginea of testes. Urology. 1988;32 (3): 259-61. Pubmed citation
- 8. Chou SJ, Liu HY, Fu YT et-al. Cysts of the tunica albuginea. Arch. Androl. 2004;50 (2): 89-92. Pubmed citation
- 9. Poster RB, Spirt BA, Tamsen A et-al. Complex tunica albuginea cyst simulating an intratesticular lesion. Urol Radiol. 1991;13 (2): 129-32. Pubmed citation
Ultrasound - testicular and scrotal
- ultrasound (introduction)
testicular and scrotal ultrasound
unilateral testicular lesion
- testicular torsion
- testicular rupture
- germ cell tumours of the testis
- sex cord / stromal tumours of the testis
- bilateral testicular lesion
- paratesticular lesions
- tubular ectasia of the rete testis
- cystadenoma of the rete testis
- testicular sarcoidosis
- testicular tuberculosis
- spermatic cord
- fibrous pseudotumour of the scrotum
- scrotal leiomyosarcoma
- testicular adrenal rest tumours (TARTs)
- tunica vaginalis testis mesothelioma
- splenogonadal fusion
- unilateral testicular lesion