Ciencia y Salud, Vol. 10, No. 3, septiembre-diciembre, 2026 • ISSN (impreso): 2613-8816 • ISSN (en línea): 2613-8824

MEDIAN RAPHE CYST ASSOCIATED WITH GRADE III PHIMOSIS IN A FIVE-YEAR-OLD BOY: A CASE REPORT

Quiste del rafe medio asociado con fimosis grado III en un niño de cinco años: reporte de caso

DOI: https://doi.org/10.22206/cisa.2026.v10i3.3732

Received: 13/04/2026 ● Accepted: 30/04/2026

How to cite: Aldaz Vallejo, F. A., Vaca Vega, W. V., Parrales Suárez, D. E., Gia Correa, C. G. (2026). Median raphe cyst associated with grade III phimosis in a five-year-old boy: a case report. Ciencia y Salud, 10(3), 109-114. https://doi.org/10.22206/cisa.2026.v10i3.3732

Introduction

Median raphe cyst is a rare benign developmental lesion of the male genitalia that may occur along the ventral midline from the urethral meatus and penile shaft to the scrotum, penoscrotal raphe, perineum, and anus. Its embryologic relevance is linked to abnormal fusion of the urethral folds and sequestration of urethral or epithelial tissue during genital development, which may explain the heterogeneous epithelial lining described on histopathology^1-5.

The condition is clinically important because it may be overlooked in childhood, remain asymptomatic, or be confused with other midline genital and perineal cystic lesions. Small, stable, asymptomatic lesions may be observed with clinical follow-up; however, complete excision is generally preferred when the lesion is symptomatic, enlarging, cosmetically concerning, infected, or diagnostically uncertain^{3, 5-8}.

This report describes a perineal/penoscrotal median raphe cyst identified during evaluation of grade III phimosis in a five-year-old boy. The case highlights the value of careful genital and perineal examination, preoperative ultrasonography to exclude urethral communication, and single-stage surgical management when a concomitant foreskin indication requires operative treatment.

Case presentation

Patient information and clinical findings

A five-year-old boy was evaluated in the pediatric surgery outpatient clinic for follow-up of grade III phimosis. During physical examination, an elongated cystic lesion was identified on the perineal/penoscrotal median raphe, in the ventral midline region. The lesion was smooth, translucent, soft, and non-tender, without erythema, discharge, or signs of local infection (Figure 1). No urinary symptoms were reported.

The exact linear length of the cyst was not documented in the available clinical record. The objective size estimate available for this report was the ultrasonographic volume, which was approximately 10 cc.

Diagnostic assessment

Because of the midline location and cystic appearance, ultrasonography was requested for preoperative assessment. Imaging demonstrated a fluid-filled lesion with an estimated volume of approximately 10 cc and no communication with the urethra. These findings supported the diagnosis of a benign cystic lesion and were useful for operative planning.

The differential diagnosis included epidermoid or dermoid cyst, parameatal urethral cyst, preputial cyst, urethral diverticulum, lymphatic malformation, and other benign midline perineal lesions. Absence of urethral communication on ultrasonography reduced concern for urethral involvement.

Therapeutic intervention

The patient underwent surgery under general anesthesia. Intraoperatively, the cystic lesion was carefully dissected from the surrounding perineal/penoscrotal raphe tissues and completely excised while preserving adjacent structures (Figure 2). Because of the associated grade III phimosis, circumcision was performed during the same procedure as definitive management of the foreskin abnormality. The immediate postoperative course was uneventful, and the patient was discharged in stable condition.

Histopathology, follow-up, and outcomes

Histopathological examination revealed a localized cyst within the dermis, without communication with the epidermis, lined by pseudostratified columnar or cuboidal epithelium with mucinous goblet cells. These findings were consistent with a median raphe cyst.

At four-month follow-up, the patient remained asymptomatic, with satisfactory wound healing and no clinical evidence of recurrence. A formal patient perspective was not obtained because the patient was a young child; no postoperative concerns were recorded from the legal guardian during follow-up. The main clinical, diagnostic, therapeutic, and follow-up events are summarized chronologically in Table 1.

Timeline

Discussion

Median raphe cyst is an uncommon congenital lesion of the male genital and perineal midline. Its presentation in childhood may be incidental, particularly when another genital condition prompts examination. In the present case, the lesion was identified during evaluation of grade III phimosis, which influenced operative planning and allowed both conditions to be treated during one anesthetic event.

The perineal/penoscrotal location is relevant because median raphe lesions can occur anywhere along the embryologic fusion line, from the meatus to the perineum. This distribution supports the proposed mechanisms of incomplete urethral fold fusion and epithelial sequestration during development. Histopathological confirmation was essential in this patient because the epithelial lining with pseudostratified/cuboidal cells and mucinous goblet cells falls within the recognized spectrum of median raphe cysts^{1, 3-5}.

Management of asymptomatic median raphe cysts is individualized. Observation with follow-up may be appropriate for small, stable, asymptomatic lesions, especially when there is no diagnostic uncertainty or functional concern. Conversely, complete excision is the most definitive approach for enlarging, symptomatic, infected, cosmetically concerning, or diagnostically uncertain cysts, and it reduces the likelihood of recurrence related to incomplete removal^{3, 5-8}. In this case, excision was favored because the lesion was relatively large by ultrasonographic volume, located in the perineal/penoscrotal raphe, and was being managed during the same operative session as the phimosis.

The coexistence of grade III phimosis also influenced treatment choice. Current evidence supports topical corticosteroids with gentle retraction as first-line treatment for many boys with symptomatic phimosis, while surgical intervention, including circumcision, is considered for persistent or pathological phimosis, recurrent inflammatory complications, failed conservative treatment, or when concomitant operative management is clinically justified^10-12. In the present patient, single-stage circumcision and cyst excision provided definitive treatment while avoiding a second anesthetic procedure.

Preoperative ultrasonography was useful because it confirmed the cystic nature of the lesion, provided the available objective size estimate, and excluded urethral communication. These aspects are important in the differential diagnosis of parameatal urethral cysts, urethral diverticula, epidermoid or dermoid cysts, lymphatic malformations, and other benign midline perineal lesions^{5, 8, 9}.

This report was structured according to the CARE case report recommendations, including patient information, clinical findings, diagnostic assessment, therapeutic intervention, follow-up, outcomes, and ethical transparency¹³. Its main limitation is that it describes a single patient and therefore does not allow generalization of findings. In addition, follow-up was limited to four months; although this period documented early healing and absence of short-term recurrence, longer surveillance would be necessary to assess late outcomes.

Conclusions

Median raphe cyst should be considered in the differential diagnosis of pediatric cystic lesions located along the ventral genital or perineal midline. In this case, careful examination during evaluation of grade III phimosis allowed recognition of a perineal/penoscrotal median raphe cyst. Ultrasonography helped define the lesion and exclude urethral communication, histopathology confirmed the diagnosis, and complete excision combined with circumcision provided favorable short-term results.

Funding

No funding was received for this study.

Authors’ contributions

Conceptualization: Freddy Aldaz, Wendy Vaca, Diana Parrales, Cesar Gia.

Investigation: Freddy Aldaz, Wendy Vaca.

Methodology: Diana Parrales, Cesar Gia.

Project administration: Diana Parrales, Cesar Gia.

Writing – original draft: Freddy Aldaz, Wendy Vaca.

Writing – review and editing: Freddy Aldaz, Wendy Vaca.

Ethical compliance and transparency statements

Ethics committee statement

This manuscript corresponds to a single anonymized clinical case. In accordance with current institutional regulations, it was not considered necessary to submit it for formal ethics committee review. If required by the journal or the institution, the authors will process the request for submission to the competent ethics committee.

Informed consent statement

Written informed consent for publication of the case details and clinical images was obtained from the patient’s legal guardian.

Reporting guideline statement

This case report was prepared in accordance with the CARE guidelines.

Use of artificial intelligence

Generative artificial intelligence assistance was used for language editing, formatting, and editorial support. The authors reviewed and verified all scientific content and accept full responsibility for the final manuscript.

Data availability statement

All relevant clinical information is contained within the manuscript.

Conflicts of interest

The authors declare no conflicts of interest.

References

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8. Tanaka K, Nakazawa-Tanaka N, Urao M. Do parameatal urethral cysts in children need surgical excision? Urology. 2022;167:198-200. https://doi.org/10.1016/j.urology.2022.05.026.

9. Elebute OA, Komolafe MD, Akinjo AO, Alakaloko FM. Preputial cyst in the newborn: a case report from Africa. Afr J Paediatr Surg. 2023;20(1):80-2. https://doi.org/10.4103/ajps.ajps_142_21.

10. Moreno G, Ramirez C, Corbalán J, Peñaloza B, Morel Marambio M, Pantoja T. Topical corticosteroids for treating phimosis in boys. Cochrane Database Syst Rev. 2024;1(1):CD008973. https://doi.org/10.1002/14651858.CD008973.pub3.

11. European Association of Urology. EAU Guidelines on Paediatric Urology [Internet]. Arnhem: EAU Guidelines Office; 2025 [citado 2026 Apr 29]. Disponible en: https://uroweb.org/guidelines/paediatric-urology.

12. Dave S, Afshar K, Braga LH, Anderson P. CUA guideline on the care of the normal foreskin and neonatal circumcision in Canadian infants. Can Urol Assoc J. 2018;12(2):E76-E99. https://doi.org/10.5489/cuaj.5033.

13. Gagnier JJ, Kienle G, Altman DG, Moher D, Sox H, Riley D; CARE Group. The CARE guidelines: consensus-based clinical case reporting guideline development. J Med Case Rep. 2013;7:223. https://doi.org/10.1186/1752-1947-7-223.

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^* Corresponding author: Freddy Alexander Aldaz Vallejo, freddyaldaz6@gmail.com

¹ Pediatric Surgeon, Rosales National Hospital, El Salvador. ORCID: https://orcid.org/0009-0003-1586-7731, email: freddyaldaz6@gmail.com

² General Surgeon, Rosales National Hospital, El Salvador. ORCID: https://orcid.org/0009-0001-8861-532X, email: wendyva7@hotmail.com

³ Pediatric Surgeon, Rosales National Hospital, El Salvador. ORCID: https://orcid.org/0009-0000-7762-8638, email: dradianaparrales@gmail.com

⁴ Pediatric Surgeon, Hospital Clínica Rodriguez, Ecuador. ORCID: https://orcid.org/0000-0002-3063-4616, email: cgtauro_85@hotmail.com