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Novel histopathologic findings in abdominoscrotal hydrocele: Clues to pathogenesis

Negar Mohammadi Ganjaroudi1, Parham Torabinavid1, Asal Hojjat1

  • 1Pediatric Urology and Regenerative Medicine Research Center, Gene, Cell and Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.

Journal of Pediatric Urology
|June 2, 2026
PubMed

Insights

Histological differences in hydrocele sac walls may explain varying behaviors of abdominoscrotal hydrocele (ASH) and communicating hydrocele (CH). ASH sacs show higher smooth muscle and myofibroblast expression, suggesting increased contractility.

Area of Science:

  • Pediatric Urology
  • Surgical Pathology
  • Histopathology

Background:

  • Hydroceles are common in pediatric patients, with abdominoscrotal hydrocele (ASH) and communicating hydrocele (CH) exhibiting distinct clinical behaviors.
  • Understanding the underlying histological differences in the hydrocele sac wall is crucial for explaining these behavioral variations.

Purpose of the Study:

  • To investigate the histological and immunohistopathological characteristics of the hydrocele sac wall in pediatric patients with ASH and CH.
  • To determine if differences in contractile units and fibromuscular components of the sac wall correlate with the distinct behaviors of ASH and CH.

Main Methods:

  • A retrospective case-control study involving 38 pediatric patients diagnosed with ASH or CH who underwent surgical management.
  • Histopathological evaluation of hydrocele sac wall samples using Hematoxylin and eosin (H&E) staining and immunohistochemical (IHC) staining for smooth muscle actin (SMA), Myogenin, and Caldesmon (H-CALD).
  • Statistical analysis was performed to compare the expression of specific markers between ASH and CH groups, with a significance level of p<0.05.

Main Results:

  • Among 38 patients, 14 presented with bilateral hydrocele; intra-operative findings confirmed no patent processus vaginalis in ASH cases.
  • Immunohistochemical evaluation revealed significantly higher expression of SMA (median 5.73% vs. 0.56%, P<0.001) and H-CALD (median 9.28% vs. 0.18%, P<0.001) in ASH sac walls compared to CH.
  • These findings indicate a greater presence of smooth muscle and myofibroblast origins in the ASH sac wall.

Conclusions:

  • The increased expression of smooth muscle and myofibroblast markers in the ASH sac wall suggests enhanced contractility, potentially contributing to secretion-reabsorption imbalances.
  • Histological examination of hydrocele sac walls provides valuable insights into the pathogenesis and clinical characteristics of ASH and CH in pediatric patients.
Abstract

Keywords:
Abdominoscrotal hydroceleHydroceleImmunohistochemical analysisPediatricsSmooth muscle actinTunica vaginalis

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