Morgagni's Hydatids

MORGAGNI'S HYDATIDS, hydatides Morgagni (from the Greek hydatis—a small bubble with watery contents); small bubble-like formations that are found on the surface of the testicle and its epididymis and represent vestigial organs that have no functional significance and may be absent entirely. A distinction is made between the sessile hydatid (ungestielte), otherwise known as the appendix testis, and the pedunculated hydatids (gestielte)—appendices epididymidis. The sessile hydatid is encountered very frequently and has the appearance of a rounded, flattened, or elongated formation 5–10 mm in length, tightly adhering to the upper edge of the testicle beneath the head of the epididymis. It consists of vascular connective tissue and contains a cavity lined with cylindrical or ciliated epithelium, which may open into a funnel-shaped depression on the surface; sometimes smooth muscle fibers are also found in the walls. Most scientists consider the sessile hydatid to be a remnant of the upper section of the Müllerian duct. The pedunculated hydatid is an elongated body that transitions into a stalk, which attaches to the head of the epididymis; there may be several of them (2–4); the structure is the same as the previous one. Views on the origin of the pedunculated hydatid diverge: some authors (Kölliker, Rauber) also consider them remnants of the Müllerian duct, while others (Wiedersheim, Prenant) consider them remnants of the Wolffian duct or the Wolffian body (see). Along with them, outgrowths of the serous membrane with transparent contents are encountered—hydatides tunicae vaginalis (Rauber). In diseases of the epididymis, testicle, and their membranes, Morgagni's hydatids are usually involved in the same process. Individual authors believe that the mere presence of Morgagni's hydatids can cause the appearance of so-called idiopathic hydrocele of the testis due to constant mechanical irritation of the latter. However, the fact that Morgagni's hydatids are encountered significantly more often than hydrocele of the testis, and that in a number of cases where strongly developed hydatids are present, hydrocele is absent, forces one to consider their role in the origin of idiopathic hydrocele to be negligible. If the hydatid has a long stalk, the hydatid may twist, and in such a case, sharp painful phenomena arise. Patients complain of a paroxysm of acute pain, accompanied by nausea and edema of the scrotal contents. The clinical picture of the disease in the initial stage does not differ from the phenomena of acute epididymitis, and differential diagnosis must be based on the absence of infection in the anamnesis (gonorrhea, tuberculosis) and on the suddenness of the disease. Subsequently, the acute phenomena quickly subside, and in the upper pole of the epididymis, corresponding to the location of the hydatid, it is possible to palpate a spherical, circumscribed, sharply painful tumor. In individual cases, the capillary vessels nourishing the hydatid sometimes become obliterated, and the latter atrophies, leaving behind a dense nodule the size of a millet seed, painful upon palpation, and sometimes even during walking or prolonged sexual arousal (neuralgia testis). Small, cartilaginous-consistency free bodies in the cavity of the tunica vaginalis apparently relate to cases of complete detachment of the indicated nodules (especially in the case of pedunculated Morgagni's hydatids). In other cases, atrophy of the hydatid does not occur, and due to the obstructed outflow of the contents of the hydatid cavity, a cystic enlargement of it is formed, which proceeds clinically in the same way as a spermatocele and differs from the latter only microscopically by the absence of spermatozoa in the contents of the cyst.