Zinner's syndrome: clinical features and imaging diagnosis

Laparoscopic excision of huge seminal vesicle cyst in Zinner syndrome

This is the case of a 45-year-old male who presented with dysuria and gross hematuria. Ultrasonography and computed tomography revealed an enormous pelvic cystic lesion and a right nephromegaly but an invisible left kidney. Using the imaging findings, the patient was diagnosed with Zinner syndrome. Transperitoneal laparoscopic excision of the cyst was performed for symptom relief. At post-treatment, the symptoms disappeared, and sexual function remained. Seminal vesicle cysts have been commonly reported in previous studies but rarely in this case. Furthermore, most previous studies have documented surgical excision of <10 cm cysts. However, a ∼12.5-cm seminal vesicle cyst was excised with the laparoscopic method without any perioperative complication in this case.

Right-sided Zinner syndrome with a left side quadrupled ureter- a case report

Zinner syndrome is a rare congenital anomaly of the genitourinary tract, consisting of ipsilateral renal agenesis, seminal vesicle cysts, and ejaculatory duct obstruction. Besides, quadruplication of the ureter is the rarest anomaly composed of proximal four ureters ending with a single distal ureter. The authors present an adult male patient with left flank pain and dysuria who was referred for abdomen CT scan. The CT scan revealed renal agenesis, seminal vesicle cysts, and obstructed ejaculatory duct, all in the right side (Zinner syndrome), and quadruplication of the ureter on the left side. The additional finding of hemivertebra was present resulting in kyphoscoliosis. Zinner syndrome and quadrupled ureter, are both rare anomalies, and the occurrence of both entities at the same patient is exceptionally rare, and have not been reported yet in the English literature. Furthermore, standard treatment protocols have to be pursued, as such patients hold a single kidney with the quadrupled ureter.

Zinner syndrome: two cases and review of the literature

Zinner syndrome (ZS) is a rare congenital malformation due to abnormal development of the urogenital tract. It is caused by a growth failure of the distal part of the Müllerian duct in early embryogenesis. It is characterised by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst and ipsilateral ejaculatory duct obstruction. Over the years, several cases have been reported in the literature since the initial report by Zinner in 1914. This syndrome is frequently misdiagnosed because it may present different patterns and the symptoms may be not specific. In this paper, we present two patients with two different patterns of presentation of Zinner syndrome.

A Newborn with Retrovesical Cysts and an Ipsilateral Multicystic Dysplastic Kidney

We present a clinical imaging question focusing on a newborn with known prenatal history of a multicystic dysplastic kidney, and an incidental ipsilateral retrovesical seminal vesical cysts, raising the diagnosis of a Zinner Syndrome. The diagnosis is challenging in this age group. Surgical management is generally proposed for symptomatic cases at older age.

Zinner’s Syndrome – The Value of Clinical Imaging and Morphopathological Findings for Diagnosis

Introduction: Cystic congenital malformations of the seminal vesicle are unusual. More than half of them are associated with ipsilateral renal agenesis. This disease was first described by Zinner in 1914, and since then, more than 200 cases have been reported. Most of the patients with this congenital disease present few symptoms until the middle-age.

Case presentation: A 61-year-old male was referred to the Urology Clinic with intermittent pain and sensibility in his lower left abdomen in the last 12 months accompanied by intermittent bowel obstruction. The digital rectal examination could not assess the prostate due to a rectal stenosis. On computed tomography and magnetic resonance imaging (MRI) a cystic tumor with close relations with the bladder wall and prostate, associated with left kidney agenesis was identified. The cystic tumor was surgically removed. The histopathological examination of the tumor revealed a multilocular seminal vesicle cyst, with a muscular wall.

Conclusions: Seminal vesicle cysts combined with ipsilateral renal agenesis are rare urological anomalies. Imaging allows a comprehensive investigation of renal and seminal vesicle anomalies. MRI seems to better visualize cysts and differentiate them from ureteroceles, while the histopathological examination contributes to a correct diagnosis. A multidisciplinary team (urologists, radiologists, and morphologists) is necessary for the proper diagnosis of Zinner’s syndrome.

Incidental finding of Zinner syndrome in a Greek military recruit: a case report of a rare clinical entity

BACKGROUND

Zinner syndrome represents a rare congenital malformation of the urinary tract. It comprises a constellation of Wolffian duct anomalies and is almost exclusively encountered as a classic triad of seminal vesicle cysts, ejaculatory duct obstruction and renal agenesis. Patients can be either asymptomatic or symptomatic. Recently, minimally invasive surgical techniques have emerged, superseding traditional surgery for select symptomatic cases. Our case highlights the finding of a rare clinical syndrome that was incidentally detected during a routine mass screening of military recruits in the Greek Armed Forces.

CASE PRESENTATION

Herein, we present a case of a 19-year-old male who reported having a solitary right kidney when examined in a military training center of Northern Greece. No additional clinical information was available; thus, referral to a tertiary urology department for further investigation ensued. Imaging studies, namely, computed tomography and magnetic resonance imaging, revealed left renal aplasia, multiple left seminal vesicle cysts, and ejaculatory duct obstruction. Laboratory values and urinalysis were within normal range. Semen analysis was significant for cryptozoospermia. Our patient remained asymptomatic during the entire hospitalization. Long-term follow-up was recommended. Nevertheless, he declined further investigation and sought treatment in a private practice setting.

CONCLUSIONS

This article aims to present the incidental diagnosis of a rare syndrome in a military setting. Population screening conducted in the armed forces permits the identification of undiagnosed diseases that warrant further investigation. To the best of our knowledge, this was the first report of Zinner syndrome in a military recruit and the second case cited of a Greek patient in the published literature. Regular follow-up is the key to timely intervention in conservatively managed cases.