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Título

Incidental Midline Prostate Cyst in a Male Adolescent: A Case Report

Introdução

Midline prostate cysts are seldom and mainly considered of congenital in origin. Such cysts might be incidental and if large enough, can cause obstructive or irritative urinary symptoms. Median cysts can be divided into Müllerian and utricular cysts.
In this case report, a 14-year-old male adolescent with pelvic pain and post-void urinary dribbling is presented.

Descrição

A 14-year-old male was hospitalized to treat a community acquired pneumonia. During hospitalization, an abdominal ultrasound was required due to pelvic pain complains in the last two weeks associated with post-void urinary dribbling. A history of nondescendent left testicle surgically corrected at 2 years of age stands out.
Transabdominal sonography presented with a slight left renal pyelocaliceal dilatation, left ureterocele, and a distended bladder with patent ureteral ostia. In the post-voiding longitudinal and transverse midline, prostate presented a cyst (at about 45 mm3) in the topography of the prostatic urethra.
T2-weighted and T1 prostate magnetic resonance confirmed a simple cyst in the superoposterior third of the prostate non-communicating with the transurethral duct. A slight T2 enhancement of the transurethral wall was also observed. Dark signal and lack of enhancement on T1-weighted images with high and homogeneous signal on T2-weighted without water restriction (water diffusion confirmed with the ADC map) reinforce a simple cyst with uncomplicated fluid.

Discussão

Midline cysts are less common and might be incidental. More seldom, if large enough, can cause obstructive or irritative urinary symptoms. Müllerian duct cysts usually occur in the 3rd and 4th decades of life whereas prostatic utricle cysts are most often detected in the 1st and 2nd decades.
Certain features differentiate Müllerian cysts from utricle cysts. Müllerian can rise high above the prostatic roof whereas utricular cysts are usually intraprostatic. Utricular cysts have a high degree of association with hypospadias, nondescendent testicles and intersex conditions. These cysts communicate with the urethra.
In the present report, a 14-years-old male presented an intraprostatic midline cyst noncommunicating with the urethra likely suggesting a Müller cyst. However, age and the presence of obstructive urinary symptoms and history of nondescendent left testicle suggest utricular cyst. Thus, the final diagnosis might come from anatomopathological and immunohistochemical analysis.

Palavras Chave

Midline prostate cysts; Müllerian cysts; Utricular cysts; Transabdominal sonography; Prostate MRI