TESTICLE (ABNORMAL ANATOMY). 



hydrocele, in which the testicle is retained 

 in the abdomen or inguinal canal, while the 

 peritoneum, prolonged for a short distance 

 into the scrotum, forms the cyst containing 

 the fluid which is covered only by the inte- 

 guments and superficial fascia. 



Encysted hydrocele of the testicle. In this 

 form of hydrocele, fluid is effused into an ad- 

 ventitious cyst or cysts distinct from the sac of 

 the tunica vaginalis. The cyst is Composed of 

 a thin delicate serous membrane, and may be 

 developed in three situations : 1. beneath the 

 visceral portion of the tunica vaginalis in- 

 vesting the epididymis ; 2. between the testi- 

 cular portion of the tunica vaginalis and the 

 tunica albuginea, which are thus separated 

 from each other ; 3. between the layers of 

 the loose or reflected portion of the tunica 

 vaginalis. The first is by far the most com- 

 mon situation, the two latter being very rare. 

 These cysts are composed of a delicate serous 

 membrane lined with tesselated epithelium, 

 and the fluid contained in them differs from 

 that of simple hydrocele in being perfectly 

 limpid and colourless, and nearly free from 

 albumen. In the cysts formed on the epi- 

 didymis, the fluid, instead of being limpid, 

 often presents an opaline opacity arising from 

 the presence of spermatozoa. 



1. Small cysts not larger than a pea, and even 

 smaller, may frequently be found beneath the 

 serous membrane covering the head of the 

 epididymis, in which they produce a slight 

 depression. In several instances I have seen 

 as many as five and six perfectly distinct 

 cysts connected with this part. 



Sometimes one or two small cysts are so 

 embedded in the substance of the epididymis, 

 that they cannot be recognised without dis- 

 section. Though these minute cysts generally 

 contain a limpid fluid, I have sometimes found 

 them filled with fluid of a milky hue, and I 

 have even observed matter like pus tinged 

 with blood. These accidental cysts some- 

 times project the tunica vaginalis before them 

 until they become so far separated from the 

 epididymis, where they were originally deve- 

 loped, as to be attached only by a narrow 

 peduncle formed by a contraction of the con- 

 necting tunica vaginalis. Such is the mode 

 of development of those small pendulous pe- 

 dunculated cysts containing a limpid fluid 

 often found hanging from the head of the epi- 

 didymis, which were erroneously supposed 

 by Morgagni to be hydatids. I have on many 

 occasions observed them in the different 

 stages of their production. Thus I have 

 seen a pedunculated cyst attached at one 

 part, whilst close to it there was a cyst of 

 a similar nature embedded in the substance 

 of the epididymis. In other instances I have 

 found the cyst very prominent, but still con- 

 nected by a broad attachment to the tunica 

 vaginalis reflected over it, the membrane not 

 having as yet contracted to form the narrow 

 neck. In all these cases the prolongation of 

 the tunica vaginalis investing the cyst could 

 always be demonstrated by cautious dissec- 

 tion, and between the membrane and the cyst 



997 



some minute red bloodvessels were generally 

 seen ramifying. These pednuculated cysts 

 never acquire a large size : I have seldom 

 found them to exceed that of a currant. 

 From the exposed situation of the testicle 

 they are liable to be ruptured, the vestiges of 

 them consisting of fimbriated folds of mem- 

 brane ; but this is not a common occurrence. 

 I have seen the delicate peduncle by which 

 the cyst was attached to the epididymis as 

 long as three quarters of an inch. M. Gosselin 

 states that small cysts are sometimes deve- 

 loped in the little appendage to the tunica va- 

 ginalis so often found connected with the 

 upper part of the testicle.* This I have never 

 seen. 



So common are small cysts connected with 

 the epididymis in the various states and stages 

 I have described, that it is impossible to 

 examine many testicles, especially of persons 

 beyond the age of puberty, without finding 

 them. According to M. Gosselin f, they are 

 liable to be developed from the period of 

 puberty to the age of thirty or thirty-five, but 

 are rare at this period. After the age of forty 

 they are very common, having been met with 

 by him in at least two thirds of the testicles 

 examined. Now when one or more of these 

 cysts, instead of becoming pedunculated, en- 

 large so as to form a tumour in the scrotum 



Fig. 640. 



* Archives GeWrales des Me'decine, 4e Se'rie, 

 t. xvi. p. 27. 



f M. Gosselin has given an elaborate account of 

 the cysts connected with the epididymis, in two pa- 

 pers published in the 16th volume of the Archives 

 Ge'nerales de Medicine. He makes two varieties of 

 them, the small and large, and states that sperma- 

 tozoa are found only in the latter. This distinction 

 I consider to be unfounded, the smaller cysts being 

 simply the early stage of the larger. M. Gosselin 

 assumes the credit of being the first to describe the 

 small cysts. They were, however, minutely de- 

 scribed by me, and illustrated in my work on the 

 Diseases of the Testis, published in 1843, of which 

 M. Gosselin could scarcely have been ignorant, since 

 he refers to my account of this form of hydrocele. 



3s 3 



