Testicular ectopia: Why does it happen and what do we do?

Testicular ectopia: A case report

This paper mainly describes three cases of children with ectopic testis, of which two patients with transverse testicular ectopia (TTE) and one with perineal ectopic testis (PET). All patients who underwent orchidopexy at the same pediatric surgical unit in the Affiliated Hospital of Jining Medical University (Jining, China) between June 2010 and February 2021 were retrospectively evaluated (age range, 14-34 months). A total of two patients (67%) was admitted with asymptomatic unilateral inguinal masses and the contralateral testis missing; the first patient was diagnosed with TTE intraoperatively, whereas the other patient was diagnosed with TTE through physical examination and ultrasound preoperatively. The third patient (33%) was admitted with the right testis missing and a left perineal mass, which was confirmed using PET by physical and ultrasound examination before the operation. The first two patients underwent transseptal orchidopexy, whereas the third patient underwent simple orchidopexy. Postoperative complications were not observed (follow-up, 10-24 months). The low incidence and poor understanding of ectopic testis compels us to report our findings and further discuss this particular disease of testicular ectopia, including its pathogenesis, diagnostic and treatment options.

Transverse testicular ectopia with persistent Mullerian duct syndrome: Report and review of two cases

Transverse testicular ectopia is a rare anomaly characterized by both testes descending through a single inguinal canal. The objective of this study was to investigate the pathogenesis, diagnosis, and treatment of transverse testicular ectopia (TTE) with persistent Mullerian duct syndrome (PMDS), and to deepen the understanding of the disease in clinical. A retrospective analysis of the clinical manifestation, diagnosis, and treatment of two children suffering from TTE with PMDS was conducted. Previous studies on the characteristics, diagnosis, and treatment of this disease were reviewed. The two patients were treated with laparoscopy-assisted transseptal orchidopexy-inguinal evaluation. After the surgery, the two patients recovered well. The follow-up visits were done 3 months after the operation. An ultrasound examination confirmed that the two patients had testes in the orthotopic position and normal size. TTE with PMDS is an exceedingly rare disease. The patients manifested cryptorchidism on one side; contralateral inguinal hernia was suspected. Detailed physical and ultrasound examinations before the operation are the key to the early diagnosis of TTE. Laparoscopic evaluation is helpful for the diagnosis and finding of other abnormalities. Surgical treatment is the only method to cure the disease; long-term follow-up is needed after TTE operation.

Left-right reversal of the testes within the scrotum: An extremely rare variant of testicular ectopia

Introduction

Testicular ectopia refers to abnormal positioning of testis, which includes a wide variety of variants. An ectopic testis is located off the normal path of male gonadal descent, unlike conventional undescended testis.

Case presentation

A 37-year-old man presented with the complaint of a palpable lesion in the scrotum. Magnetic resonance imaging of the scrotum revealed bilateral testes on the respective opposite sides of the scrotum with bilateral spermatic cords crossing under the base of the penis. Accordingly, he was diagnosed as "left-right reversal of the testes within the scrotum." In retrospect, the "palpable" lesion was thought to be the spermatic cords crossing above the testes. Semen analysis identified deteriorated sperm motility, suggesting possible male infertility.

Conclusion

This case of left-right reversal of the testes within the scrotum is probably a new variant of testicular ectopia that has never been reported.

Ectopic lesions in the abdomen and pelvis: a multimodality pictorial review

Various ectopic lesions occur in the abdomen and pelvis and affect multiple organs including liver, gallbladder, pancreas, spleen, and organs of the genitourinary system. Ectopic organs may be present outside their normal positions, or ectopic tissues may develop while the original organ exists in its normal position. Both benign and malignant lesions can occur in ectopic organs and tissues. Owing to their unusual location, they can often be misdiagnosed as other lesions or even malignant lesions, such as metastasis or seeding. This multimodality pictorial review provides various cases of ectopic lesions in the abdomen and pelvis, which will help narrow the differential diagnosis and guide clinical decision-making.

The radiologist's role in assessing differences of sex development

When infants are identified with a difference of sex development (DSD), a thoughtful approach to imaging is essential to appropriate clinical management. This review provides a comprehensive guide for radiologists who are tasked with performing this critical assignment. We review the embryologic basis of DSDs, with attention to the imaging findings that can indicate specific diagnoses. We also discuss techniques for optimal imaging, including strategies for identifying the gonads by US, tactics for performing genitograms with fluoroscopy and contrast-enhanced US, and the appropriate utilization of MRI. Finally, we review the clinical data and imaging findings that characterize some of the most common DSDs, including congenital adrenal hyperplasia, complete androgen insensitivity syndrome and gonadal dysgenesis.

Clinical Characteristics, Ultrasonographic Findings, and Treatment of Pediatric Transverse Testicular Ectopia: A 10-Year Retrospective Review

OBJECTIVE

To evaluate the clinical data, ultrasonic features, treatment, and long-term outcome of transverse testicular ectopia (TTE) in children.

METHODS

Children with TTE were enrolled in the study between November 2009 and August 2019 in Shenzhen Children's Hospital in China. Clinical information, including demographic characteristics, clinical manifestations, TTE-associated anomalies, ultrasonographic findings, and surgical procedures, were collected from all patients. Patients were re-evaluated at the end of 4 weeks and 6 months after the operation.

RESULTS

A total of 16 cases were enrolled and underwent surgeries, all patients had undescended testis with contralateral inguinal hernia. The ultrasonic findings showed two testicles in 15 cases and no testes in 1 case. Müllerian ducts remnants were found by laparoscopy in 6 cases or by ultrasound in one case. Sixteen cases were treated with laparoscopy orchidopexy or laparoscopy assisted trans-septal orchidopexy-inguinal exploration. After surgery, 16 patients had both testicles in an orthotopic position and with equal size, with normal blood flow.

CONCLUSION

TTE should be suspected in patients with nonpalpable undescended testis and contralateral inguinal hernia. The contralateral processus vaginalis sac occurs in all cases of TTE. Ultrasonography is essential for an early diagnosis of TTE. Laparoscopy-assisted surgery is safe, effective, and minimally invasive therapy for TTE.

Diagnosis and treatment of the intra-abdominal gonad in the pediatric population: Testes, ovaries, dysgenetic gonads, streaks, and ovotestes

BACKGROUND/PURPOSE

Pediatric surgical specialists are often confronted with the difficult task of identifying, diagnosing and managing intra-abdominal gonads in children. Ranging from the intra-abdominal cryptorchid testis to normal or pathologic ovaries and gonads in disorders of sexual development, all intra-abdominal gonads in the pediatric population pose different diagnosis and management challenges. Understanding the hormonal and fertility potential of the gonad and knowing its potential cancer risk is essential when deciding how to manage these patients. In addition, the ideal surgical management for each one of these patients is often debated.

METHODS

Descriptive literature review.

RESULTS/CONCLUSION

Herein, we reviewed gonadal formation, common etiologies, diagnosis and management of intra-abdominal testes, pathologic ovaries and gonads in disorders of sexual development. Fertility potential and cancer risk for each were also reviewed and how both affect surgical management of the gonad.

TYPE OF STUDY/LEVEL OF EVIDENCE

Review Article, Level V.

Bilateral ectopic femoral testes: A rare cause of empty scrotum

Empty scrotum is a relatively rare entity, with few cases reported in the literature, so far; if it coexists with bilateral ectopic femoral testes, it then constitutes an extremely rare congenital abnormality. We report a case of empty scrotum revealed at the first physical examination of a neonate. The scrotum appeared empty and no testes could be palpated in the scrotum or the inguinal canal. Two solitary, oval masses were palpable laterally of each hemiscrotum, close to femoral canal and the diagnosis of bilateral femoral ectopic testes was confirmed by the consultant pediatric surgeon.

Transverse testicular ectopia discovered following reduction of an inguinal hernia

Transverse testicular ectopia is a rare condition in which both testicles occupy a single hemiscrotum. The aberrant positioning may lead to vascular compromise or impaired temperature regulation, which elevate the risks for torsion, infertility and testicular cancer. Definitive therapy consists of orchiectomy or orchiopexy. We report a case of a 10-month-old boy with an incarcerated inguinal hernia who was discovered to have transverse testicular ectopia following hernia reduction. The patient was treated with herniorrhaphy and open transseptal orchiopexy.

Ectopias of the kidney, urinary tract organs, and male genitalia

The most frequent anomaly of the urogenital tract is a simple renal ectopia with one organ lying in the pelvis. Crossed renal ectopia is a less common condition in which the ectopic kidney is located on the opposite side of the midline from the ureteral insertion in the urinary bladder. The cause of both types of renal ectopia is the arrest or failure of the kidney ascent from the pelvic to the lumbar position. Whereas an accelerated ascent leads to a subdiaphragmal or intrathoracic ectopic position, an ectopic ureter can be defined as one that does not drain into the trigonum vesicae. The ectopic orificium can be located situated in the bladder neck and urethra as well as somewhere in the genital area.Exstrophy of the urinary bladder is not a complete ectopia. Because the abdominal wall and the anterior part of the bladder wall are lacking, the bladder mucosa grows directly into the skin. The complex exstrophy of the bladder and intestine corresponds to a cloacal exstrophy, in which the bladder is split in two halves on either side of the gut portion. Testicular ectopia refers to the location of the testis in a position outside of its normal course of descent.Prostatic ectopia does not refer to the wrong location of the entire organ, but to a scattered group of prostate glands, which are mostly found in the submucosal part of the urinary bladder or proximal urethra. Other described locations are the intestinal wall, anus, pericolic fat tissue, spleen, seminal vesicle, testis, and cervix uteri.The associated ectopic penis, scrotum, and penoscrotal transposition are the least common and probably the absolutely most unknown malformations of the male genitalia. The ectopic penis and scrotum are located in the perineum, whereas in the transposition the penis lies above the scrotum.

[Ectopias of the kidney, urinary tract organs, and male genitalia. German version.]

The most frequent anomaly of the urogenital tract is a simple renal ectopia with one organ lying in the pelvis. Crossed renal ectopia is a less common condition in which the ectopic kidney is located on the opposite side of the midline from the ureteral insertion in the urinary bladder. The cause of both types of renal ectopia is the arrest or failure of the kidney ascent from the pelvic to the lumbar position. Whereas an accelerated ascent leads to a subdiaphragmal or intrathoracic ectopic position, an ectopic ureter can be defined as one that does not drain into the trigonum vesicae. The ectopic orificium can be located situated in the bladder neck and urethra as well as somewhere in the genital area.Exstrophy of the urinary bladder is not a complete ectopia. Because the abdominal wall and the anterior part of the bladder wall are lacking, the bladder mucosa grows directly into the skin. The complex exstrophy of the bladder and intestine corresponds to a cloacal exstrophy, in which the bladder is split in two halves on either side of the gut portion. Testicular ectopia refers to the location of the testis in a position outside of its normal course of descent.Prostatic ectopia does not refer to the wrong location of the entire organ, but to a scattered group of prostate glands, which are mostly found in the submucosal part of the urinary bladder or proximal urethra. Other described locations are the intestinal wall, anus, pericolic fat tissue, spleen, seminal vesicle, testis, and cervix uteri.The associated ectopic penis, scrotum, and penoscrotal transposition are the least common and probably the absolutely most unknown malformations of the male genitalia. The ectopic penis and scrotum are located in the perineum, whereas in the transposition the penis lies above the scrotum.