Median raphe cysts of the perineum

Quiste del rafe medio perineal

Introduction: median raphe cysts (MRC) are uncommon lesions of the male genitalia. They can be found anywhere from the distal penis to the perianal area. They are caused by an incomplete closure of the median raphe during embryologic development. Objective: to present a case of MRC in an infant and provide a review on diagnosis, treatment and follow-up. Case report: one year and three months old boy, with seven 0.5 cm sized cystic lesions along the scrotum median raphe, noticed since birth. A soft tissue ultrasound demonstrated a well-circumscribed hypoechogenic solid image without any evidence of vascularity at Doppler ultrasound.  Surgical excision was conducted and histopathology confirmed the diagnosis of a median raphe cyst of the perineum, showing good progression in follow-up. Discussion: 75% of cases of MRC are asymptomatic, thus their diagnosis is often delayed. Not knowing this condition leads to confuse MRC with other similar cysts or tumors. The diagnosis is mostly clinical, although ultrasound may help to exclude other anomalies such as vascular anomalies. Surgical excision is the treatment of choice to prevent superinfection or local discomfort due to its location and size. Conclusion: Recognition of this uncommon pathology is imperative. A comprehensive evaluation of the pediatric patient is recommended to achieve an adequate diagnosis and treatment and provide appropriate information to the parents.

1. Morales-Barrera ME, Cardona-Hernández MA, González- González M, Navarrete-Franco G y col. Quistes del rafe medio tipo canal y su tratamiento quirúrgico. Dermatol Rev Mex. 2018;62(2):157-161.
2. Navalón-Monllor V, Ordoño-Saiz MV, Ordoño-Domínguez F, Sabater-Marco V, Pallás-Costa Y, Navalón-Verdejo P. Quistes de rafe medio en el varón. Presentación de nuestra experiencia y revisión de la literatura. Actas Urol Esp. 2017;41(3):205-209. http://dx.doi.org/10.1016/j.acuro.2016.06.008
3. Gafa A, Galea J, Muscat E, Shoukry M, Median raphe cyst of the penis in children. J Pediatr Surg Case Rep. 2020;53:101363. https://doi.org/10.1016/j.epsc.2019.101363
4. Otsuka T, Terauchi M. Cysts of the genito-perineal raphe: a study of 160 reported cases. Jap J Plast Reconstruct Surg. 1990;33:777–83.
5. Ravasse P, Petit T, Pasquier CJ. Perineal median raphe canal: A typical image. Urology. 2002;59(1):136. doi: 10.1016/s0090-4295(01)01520-5
6. Matsuyama S, Matsui F, Yazawa K, Matsumoto F, Shimada K, Matsuoka K. Long-term Follow-up of Median Raphe Cysts and Parameatal Urethral Cysts in Male Children. Urology. 2017;101:99–103. doi: 10.1016/j.urology.2016.10.020
7. Syed MMA, Amatya B, Sitaula S. Median raphe cyst of the penis: A case report and review of the literature. J Med Case Reports. 201913:214. https://doi.org/10.1186/s13256-019-2133-5
8. López-Candel E, Roig Álvaro J, López-Candel J, Fernández Dozagarat S, et al. Quistes del rafe medio perineal en la infancia. An Esp Pediatr 2000;52(4):395-397. https://doi.org/10.1016/S1695-4033(00)77367-X
9. Willis HL, Nieve BW, Cartwright PC, Wallis MC, Oottamasathien S, DeVries C. Parameatal urethral cysts in prepubertal males. J Urol. 2011;185(3):1042-1045. doi: 10.1016/j.juro.2010.10.038