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SM Journal of
Urology
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How to cite this article Çalışkan S, Sungur M and Baş Y. Median Raphe Cyst of the Scrotum in an Adult Patient. SM J Urol. 2015; 1(2): 1009.
https://dx.doi.org/10.36876/smju.1009
OPEN ACCESS
ISSN: 2574-8017
Introduction
Median Raphe Cyst (MRC) is a rare congenital cyst which may present anywhere between
the tip of the penis and the anus [1]. Most of the MRCs are congenital and found in childhood
[2]. Abnormal or incomplete development of the paired genital folder is the main cause of this
pathology. Here in we report a case of scrotal median raphe cyst in an adult patient presenting
palpable mass.
Case Presentation
A 54 year old male presented with complaint of swelling scrotal lesion during the one year. e
patient had no history of trauma and other remarkable medical history. In physical examination,
2.5x2 cm palpable mass was found in the middle of the scrotum (Figure 1). Surgical excision and
primary closure were performed. In the histopathological examination, the pathologist reported
that the cyst was covered by normal skin and had no communication with the epidermis, eccrine
sweat glands, hair follicles or sebaceous glands. e cyst was unilocular and there was no glandular
structure in the wall of the cyst. e cyst was lined mainly by a double layer of columnar epithelium
but in some areas were lined by cuboidal to columnar cells with transitional cells. Decapitation
secretion and mucinous cells were observed focally and these cells were positive for Alcian Blue. e
unusual observation was the presence of dendritic melanocytes among the epithelium cells. ere
was no atypia within the epithelial lining (Figure 2). Immunozhistochemical studies demonstrated
that the epithelial cells were strong positive for CK 7. Dendritic melanocytes were positive for
Melan-A (Figure 3), HMB45 and S100. CEA immunoreactivity occurred at the apical border of
the luminal cells. Scattered cells were positive for GCDFP-15 but CK20 and SMA were negative
throughout. e patient was discharged on the second postoperative day and has no complaint and
recurrence in the follow-up period of six months.
Discussion
Median raphe cysts may develop along the median raphe of the male external genitalia [3].
e cyst can be localized at anywhere on the ventral side of the genital area such as para-meatus,
glans penis, penile sha, scrotum or perineum [3]. e cyst should be distinguished from other
genital lesions such as the glomus tumor, dermoid cyst, pilonidal sinus, epidermal inclusion cyst,
urethral diverticulum and steatocystoma [3]. Median raphe cysts usually present at birth, but in
some cases, the cyst may remain asymptomatic and can be diagnosed in adulthood period. Shao et
al. [3] demonstrated that the patients were presented with a mean age of 26, 7 years (range: newborn
to 66 years) with a bimodal presentation.
According to the histopathological examinations, MRCs can be classied into 4 groups;
urethral, epidermoid, glandular and mixed [3]. e urethral type is the most common that accounts
55% of all cases. e second most common type is mixed type that consists more than one type of
epithelium; urethral epithelium with partial squamous metaplasia, uretral epithelium with scattered
or isolated mucinous cells or all 3 occuring simultaneously.
e optimal treatment is excision of the lesion [3]. Spontaneous regression of the lesion has
been reported [4], observation can be considered for the patients who hesitate to surgery and small,
asymptomatic lesions [3]. Additionally aspiration is not recommended for treatment of the MRCs.
Case Report
Median Raphe Cyst of the Scrotum in an
Adult Patient
Çalışkan S1*, Sungur M1 and Baş Y2
1Department of Urology, Hitit University, Turkey
2Department of Pathology, Hitit University, Turkey
Article Information
Received date: Aug 11, 2015
Accepted date: Nov 10, 2015
Published date: Nov 27, 2015
*Corresponding author
Çalışkan S, Bahçelievler Mah. Çamlık
Sok No:2 Çorum, Department of Urology,
Hitit University, Turkey,
Email: dr.selahattin@gmail.com
Distributed under Creative Commons
CC-BY 4.0
Article DOI 10.36876/smju.1009
Abstract
Median raphe cysts may occur at any site along the midline of the ventral side of the male genital area
between the meatus and anus. The cysts are usually asymptomatic in childhood and may progress later and
become symptomatic during adolescence and adulthood. The most common location of the cysts is penile shaft
and parameatal position, glans penis and scrotum is very rare. We present a case of median raphe cyst of the
scrotum in an adult patient who was treated with surgical excision.
Citation: Çalışkan S, Sungur M and Baş Y. Median Raphe Cyst of the Scrotum in an Adult Patient. SM J Urol. 2015; 1(2): 1009.
https://dx.doi.org/10.36876/smju.1009
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References
1. Amaranathan A, Sinhasan SP, Dasiah SD . Median raphe cysts of the
prepucial skin, with triple histological linings: a case report and review of the
literature. See comment in PubMed Commons below J Clin Diagn Res. 2013;
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2. Hara N, Kawaguchi M, Koike H, Takahashi K. Median raphe cyst in the
scrotum, mimicking a serous borderline tumor, associated with cryptorchidism
after orchiopecxy.International Journal of urology. 2004; 11: 1150-1152.
3. Shao H, Chen TD, Shao HT, Chen HW. Median raphe cysts: serial
retrospective analysis and histpathological classication. Diagnostic
Pathology. 2012; 7: 121.
4. Willis HL, Snow BW, Cartwright PC, Wallis MC, Oottamasathien S, deVries
C. Parameatal urethral cysts in prepubertal males. See comment in PubMed
Commons below J Urol. 2011; 185: 1042-1045.
Figure 1:Localization of the scrotal cyst in the operation.
Figure 2: Positive staining of Alcian blue of epithelial cells (x10).
Figure 3: Dendritic melanocytes were positive for Melan-A (x10).
