[True hermaphrodite with ipsilateral vas deferens and intrascrotal ovary]

A 15-year-old, legally male patient came to our department with chief complaint of gynecomastia. Serum testosterone was at a low level of 1.6 ng/ml, and prolactin a high level of 23 ng/ml. Blood type was a mixed type of both type A and type B, and a chromosomal analysis with peripheral blood lymphocytes demonstrated a mosaic of 46, XX/46, XY. During the follow-up, he complained a painful swelling in his right scrotum, and received an emergent surgery. A large amount of blood was noted in the right scrotum. Unicorn uterus, Fallopian tube and finbriae were observed, and a thumb-sized gonad with hemorrhage and fissure was also seen in the upper part of the scrotum. The right gonad was an ovary and no testicular tissue was confirmed in the right scrotum, whereas the right vas deferens was noted. The left testis was accompanied by an induration on its upper pole which was histologically found to be ovarian tissue. The patient was diagnosed as a true hermaphroditism with 46, XX/46, XY chimera that had an ovary with inguinal uterus hernia and an unusual vas deferens in the right scrotum and an ovotestis in the left. It was considered that an adequate amount of testosterone secreted from the left testis during the early embryonal period might have affected the descent of the right ovary into the scrotum and on the development of the right vas deferens.

Peno-scrotal transposition and the caudal regression syndrome

Peno-scrotal transposition is a rare condition of variable severity, often associated with the Caudal Regression Syndrome. A case of incomplete peno-scrotal transposition, with a perineal anorectal duplication, vesico-ureteric reflux and thoracic hemivertebrae is presented. The literature is reviewed.

Scrotoschisis as a mechanism for extracorporeal testicular ectopia

Only one case of a rare anomaly, a congenital defect in the integrity of the scrotal wall permitting egress of the testis to an ectopic extracorporeal location, has been previously reported. A second occurrence of this rare anomally is herein described with a proposed mechanism of occurrence. The condition is termed scrotoschisis.

Deoxyribonucleic acid and cytological detection of Y-containing cells in an XX hypospadiac boy with polyorchidism

A hypospadiac boy with a hypoplastic penis and an apparent 46,XX karyotype in blood and testis cultures is described. Exploratory laparotomy and bilateral gonadal biopsy revealed the presence of 2 testes in the right and 1 in the left hemiscrotum, each of which only showed hypoplastic testicular tissues histologically. Uncultured testis smears showed Y chromatin in approximately 20% of the cells. Also, the Southern blot and polymerase chain reaction analyses detected a weak but distinct signal of Y chromosome-derived deoxyribonucleic acid sequences in the perineal skin but not in the blood lymphocytes. The results indicated that the boy had a small proportion of Y chromosome-containing cells in the form of mosaicism in limited tissues, such as the testes and perineal skin. This finding may have implications in the genesis of testes in some cases of XX patients, and true hermaphrodites or male pseudohermaphrodites with an apparent 46,XX karyotype. To our knowledge, this appears to be the first case of polyorchidism with an identified chromosome abnormality.

Fetal abdominoscrotal hydrocele

A case of abdominoscrotal hydrocele detected initially as an intraabdominal cyst on antenatal ultrasonography is described. Abdominoscrotal hydrocele should be included in the differential diagnosis of antenatally recognized intraabdominal cysts and abdominal masses in the newborn.

[Congenital perineal lipoma with accessory scrotum: a case report]

A tumor mass covered with scrotum-like skin on its tip was found on the perineal region of 3-year-old boy since his birth. The mass was diagnosed as congenital lipoma, which was resected, because of its gradual enlargement. Histopathological findings of the tumor indicated perineal lipoma, and the scrotum-like portion was diagnosed as an accessory scrotum. In the Japanese literature, 7 congenital perineal lipomas (6 males, 1 female) have been reported and all male cases except 1 case (no description about scrotum) were accompanied with an accessory scrotum. We conclude that there may be a close relationship between congenital perineal lipoma and accessory scrotum.

Accessory perineal scrotum associated with anorectal malformation. A report of 2 cases

Two new cases of accessory perineal scrotum in association with anorectal malformation are reported. The development of accessory scrota--as distinct from ectopic scrota--can be attributed to abnormal migration of the labioscrotal swellings.

Incomplete penoscrotal transposition associated with hemivertebrae

Penoscrotal transposition is a rare anomaly of external genitalia, often associated with a variety of defects usually related to the urinary and the gastrointestinal tracts and the vertebral column. We report such a patient with hemivertebrae at L4-5, who had no other urological anomaly. To our knowledge this anomaly as an isolated urological entity with hemivertebrae has not been reported before. A brief mention is made of the embryology, incidence and various surgical techniques of correction.

Aarskog syndrome

Images

Androgen receptor disorder in three brothers with bifid prepenile scrotum and hypospadias

Three brothers with congenital transposition of the penis, scrotal hypospadias, bifid scrotum, and bilateral undescended testes are described. Further signs of incomplete virilization, but no gynecomastia were seen. LH and FSH were elevated, whereas testosterone levels were reduced or in the normal range. Serum concentrations of 17-hydroxyprogesterone, dehydroepiandrosterone, androstenedione, 5 alpha-dihydrotestosterone and estradiol measured in two affected brothers were in the normal range. Fibroblasts from scrotal skin biopsies performed in two patients showed normal 5 alpha-reductase activity (419 and 214 pmol.(mg protein)-1.h-1; normal greater than 1), whereas androgen receptors had reduced maximal binding capacity (Bmax 4 and 14 fmol.(mg protein)-1; normal greater than 18) and an increased equilibrium dissociation constant (0.7 and 1.26 nmol/l: normal 0.2 +/- 0.08) indicating a quantitative and qualitative androgen receptor defect. These patients represent a further variant of androgen insensitivity.

[Lip-jaw split in a calf. Comments on the article, "Cornea dermoids and double malformations of the nares in a calf," by C. Neophytou]

A case of Cheilognathoschisis in a bull calf is demonstrated. The author supposes, that the malformation, which Neophytou reported, was a cheilognathoschisis too.

Accessory scrotum with lipoma in an infant

We report on a 2-year-old male infant with accessory scrotum with lipoma presenting a perineal mass. Preoperatively no abnormality in the urinary tract and the anorectum was demonstrated. The tumour was resected and perineoplasty was performed. The resected specimen histologically revealed lipoma with tissue suggestive of scrotum. The patient recovered well and was discharged with no clinical complaints. This rare congenital anomaly is described in this paper. The slight continuity between the left scrotum and an accessory scrotal tissue in this case may suggest that this rare anomaly was derived from some abnormality in the migration of precursor tissue of scrotum.

Accessory scrotum: report of a case

Perineal ectopic (accessory) scrotum is an uncommon anomaly. We could trace only 5 such cases reported in the literature (8, 10, 11). A case of accessory scrotum and glandular hypospadias has been presented and discussed.

Diphallus with third urethra

An unusual case is reported of a fifteen-year-old adolescent boy, who was born with two independent phalli. Both organs featured separate, completely developed urethras, including an extra urethral remnant in the right penis. A third hypospadic perineal urethral duct equipped with a mechanical sphincter also could be identified histologically. Bilateral simultaneous erections could be achieved easily. A review of published cases suggests that this may be the first example of a complete diphallia coexisting with a third urethra.

Case report of a boy with penoscrotal transposition, double urethra, pseudodiphallia, and ectopic scrotum

The paper describes a 14 year old Saudi boy with penoscrotal transposition and double urethra placed side by side in the penis. Ectopic scrotal skin and a pseudopenis were seen over the right ischial tuberosity. The patient had a large lumbosacral lipoma, which probably caused paralysis and atrophy of the right leg through an intraspinal extension.

[Penoscrotal inversion]

A case of a child with complete penoscrotal transposition is presented. Surgical correction was performed in two stages. First, we performed penile elongation with scrotoplasty and partial perineal urethroplasty with the Thiersch Duplay technique, followed by Byars urethroplasty. The surgical techniques commonly used to correct this anomaly and their indications are reviewed. Currently, we recommend correction of hypospadias and transposition in a single stage procedure whenever possible.

Partial transposition of the penis and scrotum with anterior urethral diverticulum in a child born with the caudal regression syndrome

Caudal regression is a rare anomaly often associated with urogenital abnormalities. We report a case of the caudal regression syndrome associated with partial transportion of the penis and scrotum, and a giant anterior urethral diverticulum. We also report our surgical technique for 1-stage reconstruction of the external genitalia, as well as a review of the embryological development of this anomaly.

[Penis agenesis]

Congenital absence of the penis is a very rare malformation. The incidence is about 1:30 million persons or 1:16,000 necropsies. The cause of the malformation is unknown. Frequent associated malformations of the lungs, the colon and the urinary tract are determinating the prognosis. The therapy of choice in case of isolated penile agenesis is primary orchidectomy, later vaginoplasty and hormonal feminisation. We report our experience with two cases.

Value of sonography in true complete diphallia

A case of true complete diphallia associated with multiple malformations is presented. Complete radiological evaluation should include sonography of both penes preoperatively to classify the penile duplication correctly.

Frontonasal dysplasia, congenital heart defect, and short stature: a further observation

We present a mildly retarded boy with frontonasal dysplasia, valvular aortic stenosis, short stature, and small head circumference. In addition, mild genital anomalies and bilateral Sydney lines were present. Strikingly similar cases recently published by de Moor et al suggest a defined clinical entity.

Surgical correction of complete bifid scrotum using subcutaneous pedicle flaps; a report of two cases

A method of surgical correction for the separation and severe transposition of the scrotum associated with perineal hypospadias is reported. Although this is a rare congenital anomaly, we have treated two cases in the past 7 years. A technique has been devised by which the scrotum is divided into two subcutaneous pedicle flaps, enabling complete correction of the transposed penis and scrotum.

[Knee pterygium syndrome in a newborn infant]

We report on a newborn boy with popliteal pterygium syndrome. Congenital anomalies included popliteal pterygia, symblepharon, cleft lip and palate with syngnathia, severe hypoplasia of both thumbs, a characteristic nail anomaly of both first toes, multiple syndactylies, and a hypoplastic scrotum with cryptorchidism. Mental development can be expected to be normal. Overall prognosis of the disorder after detailed operative correction is apparently favorable. Differential diagnosis is discussed in detail. The syndrome is autosomal dominantly inherited, our patient represents an isolated case.

Diphallia associated with malformation of hindgut derivatives

A case of diphallia associated with bifid scrotum and duplication of urethra, bladder, and large intestine is reported.

[Scrotopenile inversion: a report of 4 cases]

From Sep. 1980 to July 1987, 4 cases of scrotopenile inversion were treated surgically. There were complete and partial scrotopenile inversion in 2 cases respectively. A pedicle skin tube of scrotum was used to prolongate the urethra and correct the curved penis. The operation was performed at a time in 3 cases and satisfactory results were obtained in all 4 cases.