Detached ciliary tufts in the epididymis: a lesson in applied anatomy

We report a case of detached ciliary tufts (DCTs) discovered in the aspirate from an epididymal cyst in a 30-year-old man undergoing epididymal exploration for obstructive azoospermia. The specimen was initially misdiagnosed as a parasite due to its appearance and spontaneous motion on fresh smear. Since standard urology and histology texts identify ciliated cells only in the efferent duct of the male genital tract, the source of DCTs in this patient was mysterious. However, on further review, histologic studies have demonstrated that the first portion of the epididymis represents an extension of the efferent ducts and is lined with cilia. The fact that the caput epididymis is composed of branched efferent ducts has significant implications for our understanding of congenital absence of the vas, epididymal sperm aspiration, spermatoceles, and epididymal physiology.