Polyorchidism: a meta-analysis

A Rare Case of Polyorchidism: Four Testes

Background

Polyorchidism or supernumerary testis means more than two testes. It is very rare and to the best of our knowledge, there have been only about 200 cases reported.

Case Report

In this case report we want to present radiological features and assessment of a patient with four testicles.

Conclusions

If the vascularity and echogenicity of the scrotal mass is similar with the normal testis parenchyma, multitestis should be considered. The MRI might not provide us with additional information to USG or CDUSG, thus it is not necessary to perform it if there is no suspicion of malignancy.

"Rosary of Testes": Splenogonadal Fusion in Association with Bilateral Abdominal Testes Presenting as Polyorchidism

Polyorchidism is a rare anomaly where early segmentation in the gonadal ridge can lead to the development of three or less commonly four testes in one individual. Just over 150 reports of this phenomenon exist in English medical literature. However, once confronted by the clinical finding of supernumerary gonads, one must remain mindful of other likely diagnoses involving nontesticular origin. We report on a male patient with bilaterally impalpable testes in whom splenogonadal fusion mimicked polyorchidism. By keeping such differential diagnoses in mind, surgeons are more liable to take the appropriate intraoperative course of action.

Quadruple Orchidopexy for Torsion Testis in an Adolescent With Polyorchidism: A Case Report

We report a case of testicular torsion in an adolescent with polyorchidism, specifically quadorchidism. Sonographic and intraoperative images are provided to describe the presentation and management of this case, while the challenges and pitfalls with this clinical scenario are discussed.

Report of a boy with polyorchidism and a review of current knowledge regarding this unusual anomaly

Polyorchidism is an extremely rare testicular malformation in children, and its etiology is unknown. There is an increased risk for testicular malignancy in these patients and a common association with other abnormalities, such as cryptorchidism, inguinal hernia, testicular torsion, hydrocele, and varicocele. There are insufficient data in the literature on the ideal management of polyorchidism. We report a 14-year-old boy with polyorchidism and review the current literature regarding this anomaly. Physical examination revealed a discrete, painless, left intrascrotal lump. αFP, β-hCG and LDH were normal. Scrotal ultrasound showed a well-circumscribed tissue in the left hemiscrotum measuring 2.5×2.0×1.3 cm and having the same echo-genicity as the normal testes. Color Doppler study and magnetic resonance imaging also confirmed the tissue as a third testis with its own epididymis draining to a common vas. The testis was left in situ, and the patient was managed conservatively. Polyorchidism should be considered in the differential diagnosis of all scrotal masses. The etiology of polyorchidism is thought to be accidental division of the genital ridge before 8 weeks of gestation. The cases are divided into two categories according to anatomical properties, such as having drainage to an epididymis and vas deferens. The majority of cases are mainly encountered during evaluation for the other symptoms associated. Recent evidence supports that these cases may be followed conservatively when clinical findings and imaging techniques detect no complications or suspicion for malignancy, torsion, hernia, or cryptorchidism.

Three testicles in one hemiscrotum: an unusual presentation of polyorchidism

Polyorchidism, or more than one testicle in a hemiscrotum, is a relatively rare phenomenon. It is often associated with several other conditions, including inguinal hernia, testicular maldescent, testicular torsion, hydrocele or hypospadias. In this report, we describe a patient who presented with three testicles in one hemiscrotum, which is a highly unusual presentation for an already uncommon condition. We also review the relevant literature as it relates to the need for surveillance due to the increased risk for malignancy.

Polyorchidism: two case reports and a review of the literature

Introduction

Polyorchidism is a very rare anomaly that is defined by the presence of more than two testes. Although its presentation is primarily as triorchidism, cases of four testes have also been reported in the literature.

Case presentation

In this report, we describe color Doppler ultrasound findings in two cases. Patient 1 was a 37-year-old Arabic man with a scrotal mass and a double testicle in the right hemiscrotum visualized by ultrasound. Patient 2 was an 11-year-old Arabic boy with an inguinal mass resulted to be an additional testicle in the inguinal canal. The echogenic texture and vascular flow of supernumerary testicles in question were similar to those of the normal testicles; however, their size was smaller. After 3 years of follow-up, the tertiary testes in the two patients remained stable in both size and echogenicity.

Conclusion

Ultrasound plays a crucial role in the evaluation of masses. Notably, inguinal or scrotal masses should not always be considered as lymph nodes or tumors. Indeed, a radiologist should always keep polyorchidism in mind when such masses are encountered.

Polyorchidism with presumed contralateral intrauterine testicular torsion

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The sentence, “Since then fewer than 200 cases have been reported in children and adults²” has been updated to “Since then nearly 230 cases of polyorchidism have been reported with a meta-analysis revealing 140 cases of histologically confirmed polyorchidism in children and adults.²”

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The sentence “It occurs mostly on the left side, with only a few reports of right sided polyorchidism^3,4” has been changed to “Right sided polyorchidism is less common than on the left side.”

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Prenatal testicular torsion reportedly occurs in approximately 6.1 per 100,000 births.^7,8 The frequency may be higher given that the infarcted testis gets resorbed giving rise to reports of the “vanishing testis” as is most likely in this case.⁸ While prenatal testicular torsion is increasingly being recognized and treated as a surgical emergency,⁹ prenatal testicular torsion in association with polyorchidism has not been previously reported.” has been included.

INTRODUCTION

Polyorchidism was first described by Blasius in 1670¹ during a routine autopsy. We report a child with unilateral polyorchidism and a contralateral absent testis, a combination not reported previously.

PRESENTATION OF CASE

A 2-year-old boy was referred to the outpatient clinic with an impalpable left testis. At laparoscopy, the left vas deferens and testicular vessels ended blindly proximal to a closed internal ring. No gonadal tissue was identified. On the right side, a single vas deferens and testicular vessels were seen entering the internal ring as normal. The right side of the scrotum was explored and two testes were identified within a single tunica vaginalis.

DISCUSSION

Polyorchidism is rare with a literature search identifying approximately 230 reported cases. Whilst prenatal testicular torsion is increasing being recognized and treated as a surgical emergency,⁹ prenatal testicular torsion in association with polyorchidism has not been previously reported.

CONCLUSION

We describe a unique case of a 2-year-old boy with right-sided polyorchidism and an absent left testis associated with a blind ending vas deferens and testicular vessels, presumed secondary to intrauterine testicular torsion.

Functional supernumerary testis in a child with testicular torsion and review of polyorchidism

Histologically confirmed polyorchidism is an uncommon condition. The majority of cases are asymptomatic and associated with inguinal hernia or cryptorchidism. There are few reported cases of pediatric supernumerary testis presenting with testicular torsion. We present a case of missed torsion with incidentally detected triorchidism as well as an overview of pediatric polyorchidism.

Supernumerary testis: Imaging appearance of a rare entity

Supernumerary testis is a rare congenital anomaly of the testis arising from abnormal division in the genital ridge during the embryogenesis of testis. We describe a case of polyorchidism detected incidentally in a 52-year-old with renal failure.

Management of a bilobed testicle in a 12-year-old boy

A bilobed testicle is an extremely rare congenital malformation, with only five cases published to date. We present the case of a 12-year-old boy with a bilobed testicle. With so few cases available, much of what is known about the management of this condition is based on cases of polyorchidism and the complications associated with this, including malignancy and torsion. Whilst surgery may play a role in some patients, uncomplicated cases can be managed conservatively. There is no long-term data on the outcome of conservative management but we propose this patient can be discharged if no further changes are identified after 18 months.

Triorchidism: a rare genitourinary abnormality

Polyorchidism is an extremely rare congenital anomaly which refers to the presence of more than two testicles. There are very few reports of triorchidism in a 2 year old child. Polyorchidism is usually discovered incidentally. The most common anomalies associated with polyorchidism are inguinal hernia (30%), maldescended testis (15% to 30%), testicular torsion (13%) and hydrocele (9%). A 2-year-old child was brought with bilateral undescended testis with normal milestones. Ultrasonography of scrotum and abdomen showed both the testes to be in inguinal canal. Intra-operatively, on left side - there were two testes, which belonged to Leung III class and one testis on right side. Management of polyorchidism is still controversial. The management of polyorchidism will depend upon the location, size and anatomical organisation of the testicular drainage system and the age of the patient.

Elements of morphology: standard terminology for the external genitalia

An international group of clinicians working in the field of dysmorphology has initiated the standardization of terms used to describe human morphology. The goals are to standardize these terms and reach consensus regarding their definitions. In this way, we will increase the utility of descriptions of the human phenotype and facilitate reliable comparisons of findings among patients. Discussions with other workers in dysmorphology and related fields, such as developmental biology and molecular genetics, will become more precise. Here we introduce the anatomy of the male and female genitalia, and define and illustrate the terms that describe the major characteristics of these body regions. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Polyorchidism: a torted right-sided supernumerary testis

Polyorchidism is a rare congenital anomaly defined by the presence of more than two histologically proven testes. The commonest variant is triorchidism, the supernumerary testis being commonly reported on the left side. Most cases of polyorchidism are found incidentally in association with undescended testis, hydrocele, hernia or torsion. We report a right-sided triorchidism in a 15-year-old boy found at time of groin exploration for an irreducible right inguinal hernia.

Incomplete unilateral polyorchidism (bilobed testicle) mimicking testicular tumour

Incomplete polyorchidism (also called bilobed testicle) is an extremely uncommon congenital anomaly. Only 3 cases of bilobed testicle were previously reported in the available literature. We describe a case of a 4-year-old boy who presented with a 6-month history of an asymptomatic scrotal mass located in the upper pole of the left testicle mimicking testicular tumour. After partial orchiectomy, macroscopic and pathological examination of the lesion confirmed the diagnosis of normal testicular tissue.

Polyorchidism: color Doppler ultrasonography and magnetic resonance imaging findings

Polyorchidism, the presence of more than two testes, is a very rare anomaly. We report the color Doppler ultrasonography and magnetic resonance imaging findings of the case of a 20-year-old man with polyorchidism, presenting with an asymptomatic scrotal mass. Ultrasonography showed double testes with double separate epididymides sharing a common vas deferens in the left side of the scrotum. The double testes demonstrated similar echo texture and vascular flow as the normal testis, but smaller in size. Magnetic resonance imaging showed three testes very clearly and confirmed the diagnoses. After 2 years of follow-up, he was managed with surgical intervention. Pathology report revealed polyorchidism.

Polyorchidism: sonographic and magnetic resonance imaging findings

Polyorchidism is a rare anomaly and frequently associated with criptorchidism, inguinal hernia and testicular torsion. It is also reported as increased risk of testicular malignancy. We report a case of 23 year old man with left supernumerary testis in the left hemiscrotum. He presented with painless mass in his left hemiscrotum. Normal physical examination and laboratory tests including spermiogram were examined. Both ultrasound and MRI examinations revealed polyorchidism without malignancy or any other concomitant features. In most cases sonography alone is diagnostic. MRI may provide additional information in complicated cases of polyorchidism. Conservative treatment with sonographic follow-up is the choice of treatment in uncomplicated cases.

[Polyorchidim: a case report and review of the literature]

A 28-year-old male presented with a small painless lump in his left hemiscrotum. A physical examination revealed a non-tender mass that was palpable on the tail of left epididymis, and the testis and spermatic cord were normal. Ultrasonography showed an isoechoic round shaped tumor, 16 mm in diameter. An exploration of the scrotum was performed, based on a preoperative diagnosis of a left epididymal tumor. The tumor was located below the tail of epididymis, and had a whitish capsule, which looked similar to tunica albuginea testis. A frozen section revealed testicular tissue without any malignant change, and therefore polyorchidism was diagnosed. The accessory testis was resected because there was no connection with the epididymis and vas deferens. Polyorchidism is a rare congenital anomaly with 24 cases reported in the Japanese literature. The indications for the resection of an accessory testis are controversial. Patients with intrascrotal polyorchidism might be recommended to undergo a resection of the accessory testes if there are signs of dysplasia during an intraoperative biopsy. Patients must be followed up with regular clinical and ultrasonic examinations when accessory testes are preserved. However, extrascrotal supernumerary testes should be managed by an orchiectomy because of the increased risk of malignancy.

Three small testes in left hemiscrotum: a rarer case of polyorchidism

Polyorchidism is a rare congenital anomaly. A review of literature has yielded about 100 cases. We describe a rarer case of polyorchidism consisting of 3 testes on left hemiscrotum and one normal testis in right hemiscrotum. Diagnosis and management are discussed.