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Hakimi T, Hassani GS, Hassani AF. Supernumerary testis or polyorchidism: A rare urogenital anomaly (case report and literature review). Int J Surg Case Rep 2024; 120:109837. [PMID: 38833904 PMCID: PMC11180330 DOI: 10.1016/j.ijscr.2024.109837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Polyorchidism, or supernumerary testis, is a rare urogenital congenital disorder. Because of its rarity, there is no approved standard treatment protocol for preserving or removing the extra testicle, yet orchiopexy is frequently performed as a preferred treatment in most medical facilities. CASE PRESENTATION We present a 23-year-old single male with a bilaterally empty scrotum. He was unaware of his condition and had not seen a doctor before being admitted to our surgical unit. During his younger sibling's circumcision by a local circumcisionist (a medical staff member, idealy a nurse, whose duty is to perform circumcision, preferably at home), he saw something different (his emptey scrotum) and came to us with his problem. Laboratory findings revealed severe oligospermia, and tumor markers (Alpha fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase) were negative for malignancy. The patient underwent bilateral herniorrhaphy and orchiopexy of all six testicles (three in each inguinal canal) and had an uneventful recovery. CLINICAL DISCUSSION As polyorchidism is not a common problem, its management remains a contentious issue due to the lack of evidence-based consensus. However, with the introduction of new imaging modalities and on-table frozen section biopsy, the decision to continue with orchiopexy or orchiectomy can be easily justified; however, conservative treatment is preferable in cases of no coexisting anomalies, particularly cryptorchidism. CONCLUSION Polyorchidism could run unnoticed for years, especially if there is no direct and consistent access to a medical facility. In cases where polyorchidism is detected accidentally by imaging or during surgical exploration, the treatment must be justified accordingly.
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Affiliation(s)
- Turyalai Hakimi
- Department of Pediatric Surgery, Kabul University of Medical Science, Maiwand Teaching Hospital, Kabul, Afghanistan.
| | - Ghulam Sakhi Hassani
- Department of Urology, Kabul University of Medical Science, Ali Abad Teaching Hospital, Kabul, Afghanistan
| | - Ahmad Fahim Hassani
- Department of General Surgery, Kabul University of Medical Science, Ali Abad Teaching Hospital, Kabul, Afghanistan
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Edo H, Yagi F, Mizuno M, Okada M, Hyoe E, Ozaki I, Akita H, Jinzaki M, Shinmoto H. Extratesticular masses focusing on MRI findings. Jpn J Radiol 2024:10.1007/s11604-024-01605-4. [PMID: 38836965 DOI: 10.1007/s11604-024-01605-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
Scrotal masses, whether cystic or solid lesions, are routinely evaluated using ultrasonography. Magnetic resonance imaging (MRI) may be used for further investigation in cases with atypical findings, difficult diagnoses, large masses, and/or unclear relationships with the surrounding tissues. Scrotal solid masses are divided into intra- and extra-testicular masses. A staggering 90% of the intratesticular masses are malignant, whereas 75% of extratesticular masses are benign. Extratesticular masses are less common than intratesticular masses; however, some extratesticular masses present characteristic MRI findings. Familiarity with these specific MRI features of extratesticular masses is beneficial to radiologists, as appropriate diagnoses can help avoid unnecessary invasive treatments such as orchiectomy. In this review, we describe fibrous pseudotumors, polyorchidism, adenomatoid tumors, and scrotal leiomyoma as benign paratesticular masses, focusing on their characteristic imaging features on MRI. Although these tumors are extremely rare, their MRI findings are distinctive, and accurate diagnoses can prevent unnecessary orchiectomy. In addition, to demonstrate the pitfalls of diagnosing extratesticular masses, we present a case of seminoma misidentified as extratesticular masses due to large extensions outside the testis. Spermatic cord sarcoma, including rhabdomyosarcoma, leiomyosarcoma, and liposarcoma, and metastasis to the spermatic cord are described as malignant extratesticular masses. This review focused on extratesticular masses and elaborates the imaging findings that can aid in the accurate diagnosis using MRI.
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Affiliation(s)
- Hiromi Edo
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan.
| | - Fumiko Yagi
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mariko Mizuno
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchikami-Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Masahiro Okada
- Department of Radiology, Nihon University School of Medicine, 30-1 Oyaguchikami-Machi, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Eiko Hyoe
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Ippei Ozaki
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
| | - Hirotaka Akita
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Masahiro Jinzaki
- Department of Diagnostic Radiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Hiroshi Shinmoto
- Department of Radiology, National Defense Medical College, 3-2 Namiki, Tokorozawa-shi, Saitama, 359-8513, Japan
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Pliszka A, Wawrzyniak A, Walocha J, Musiał A, Bonczar M, Ostrowski T, Polguj M, Wysiadecki G, Clarke E, Tubbs RS, Balawender K. Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review. Clin Anat 2024; 37:405-412. [PMID: 37493239 DOI: 10.1002/ca.24093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/27/2023]
Abstract
Polyorchidism, a congenital malformation characterized by supernumerary testes (SNTs), is usually revealed incidentally during ultrasound or open scrotal surgery. In the approximately 200 cases so far published in the literature, the left side is affected more often than the right. Despite the rarity of this anomaly, a surgeon must have basic knowledge of its embryological basis and classifications to implement proper treatment and avoid overlooking it, since the consequences could harm the patient. This review summarizes previous classifications. It can be assumed that determining the risk of malignancy, and the level of reproductive potential based on location, vascularization, ductus deferens drainage, and environmental factors (e.g., temperature) affecting the SNTs, indicates the best approach to management. Therefore, we have created a new classification based on previous ones, addressing the aforementioned issues, which will guide the clinician to select the most appropriate treatment.
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Affiliation(s)
- Anna Pliszka
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Rzeszow University Medical College, Rzeszow, Poland
| | - Agata Wawrzyniak
- Department of Histology and Embryology, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Jerzy Walocha
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Agata Musiał
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
| | - Michał Bonczar
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Tomasz Ostrowski
- Department of Anatomy, Jagiellonian University Medical College, Kraków, Poland
- Youthoria, Youth Research Organization, Kraków, Poland
| | - Michał Polguj
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Grzegorz Wysiadecki
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - Edward Clarke
- Department of Normal and Clinical Anatomy, Chair of Anatomy and Histology, Medical University of Lodz, Poland
| | - R Shane Tubbs
- Department of Neurosurgery, Tulane Center for Clinical Neurosciences, Tulane University School of Medicine, New Orleans, Louisiana, USA
- Department of Neurosurgery, Ochsner Neuroscience Institute, Ochsner Health System, New Orleans, Louisiana, USA
- Department of Anatomical Sciences, St. George's University, St. George's, Grenada
- Department of Structural and Cellular Biology, Tulane University School of Medicine, Louisiana, USA
| | - Krzysztof Balawender
- Department of Normal and Clinical Anatomy, Institute of Medical Sciences, Rzeszow University Medical College, Rzeszow, Poland
- Department of Clinical Urology and Urological Oncology, Municipal Hospital of Rzeszow, Rzeszow, Poland
- Faculty of Medicine, University Sulkhan-Saba Orbeliani University LLC, Tbilisi, Georgia
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Sarmiento B, Ellsworth P, Seth A. Inguinal Polyorchidism Found Incidentally During Orchiopexy in 9-Year-Old Male: A Case Report and Review of Orchiopexy of Nonscrotal Supernumerary Testes. Urology 2024; 184:e235-e238. [PMID: 37951364 DOI: 10.1016/j.urology.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 10/23/2023] [Indexed: 11/14/2023]
Abstract
Polyorchidism, the presence of more than two testes, usually presents as a painless scrotal mass or is diagnosed incidentally during the management of another condition.1 It is a rare congenital abnormality with approximately 200 reported cases in the literature. Most cases are found on the left side within the scrotum. We report a case of right-sided polyorchidism in a 9-year-old patient found incidentally during inguinal orchiopexy. As there is debate on the management of polyorchidism, a careful approach is required as the surgeon must decide between either scrotal fixation or the removal of the supernumerary testis. This case report will discuss the anatomical and clinical considerations when making this decision.
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Kanbar A, Dabal C, El Khoury J, Halabi R, Assaf S, Mina A, Breidi S, Abdessater M, El Khoury R. Diagnosis and Management of Polyorchidism: A Case Report and Literature Review. Case Rep Urol 2023; 2023:1620276. [PMID: 37397169 PMCID: PMC10310454 DOI: 10.1155/2023/1620276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/23/2023] [Accepted: 06/13/2023] [Indexed: 07/04/2023] Open
Abstract
Polyorchidism, or supernumerary testis, is a rare congenital abnormality of the genitourinary system. In this paper, we present the case of triorchidism in a seven-year-old asymptomatic child with a suspect left scrotal mass detected on routine physical examination. Imaging studies revealed a third testicle in the left hemiscrotum, with comparable dimensions, signal intensity on MRI, and Doppler flow on ultrasound with the ipsilateral testis. We also discuss the clinical presentations, classifications, and current diagnostic and therapeutic strategies of this condition.
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Affiliation(s)
- Anthony Kanbar
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Charbel Dabal
- Urology Department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon
| | - Joey El Khoury
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Rami Halabi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Serge Assaf
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Anthony Mina
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Sabine Breidi
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
| | - Maher Abdessater
- Urology Department, Notre Dame des Secours University Hospital Center (CHUNDS), Byblos City, Lebanon
| | - Raghid El Khoury
- School of Medicine and Medical Sciences, Holy Spirit University of Kaslik (USEK), P.O. Box 446, Jounieh, Lebanon
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Arena L, Szklarz T, Costabel M, Maguiña P, De Carli C. A Case of Conservative Management of Intra-abdominal Polyorchidism in a Child. Urology 2023; 176:187-189. [PMID: 36948361 DOI: 10.1016/j.urology.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/21/2023] [Accepted: 03/01/2023] [Indexed: 03/24/2023]
Abstract
Polyorchidism is defined as the presence of 2 or more testes on the same side. A 7-year-old boy (46 XY) with multiple congenital abnormalities and nonpalpable bilateral gonads is presented. He underwent diagnostic laparoscopic surgery at 8 months old which revealed duplicated right testes and contralateral presence of persistent left Mullerian duct structures. A successful Fowler-Stephens orchidopexy in 2 stages was performed on both testicles. Postoperative ultrasonography showed orthotopic right testes of 0.15 and 0.28 cc. We propose testicular preservation in these patients to prevent early anorchia.
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Affiliation(s)
- Luciano Arena
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina.
| | - Tatiana Szklarz
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| | - Macarena Costabel
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| | - Pamela Maguiña
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
| | - Claudio De Carli
- Pediatric Surgery Service, Hospital Provincial Neuquén, Neuquén. Argentina
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Gabriel H, Hammond NA, Marquez RA, Lopes Vendrami C, Horowitz JM, Casalino DD, Nikolaidis P, Miller FH, Bhatt S. Gamut of Extratesticular Scrotal Masses: Anatomic Approach to Sonographic Differential Diagnosis. Radiographics 2023; 43:e220113. [PMID: 36893051 DOI: 10.1148/rg.220113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
The commonly taught tenet that intratesticular lesions are always malignant and extratesticular scrotal lesions are always benign is a simplistic statement that erroneously minimizes the significance of extratesticular scrotal masses and their diagnosis. Yet, disease in the extratesticular space is commonly encountered by clinicians and radiologists and is often a source of uncertainty in diagnosis and management. Given the embryologically rooted complex anatomy of this region, a wide range of pathologic conditions is possible. Radiologists may not be familiar with some of these conditions; further, many of these lesions can have a specific sonographic appearance, allowing accurate diagnosis that can minimize surgical intervention. Lastly, malignancies can occur in the extratesticular space-although this is less common than in the testicles-and proper recognition of findings that warrant additional imaging or surgery is critical in optimizing outcomes. The authors present a compartmental anatomic framework for differential diagnosis of extratesticular scrotal masses and provide a comprehensive illustrative display of many of the pathologic conditions that can be encountered to familiarize radiologists with the sonographic appearances of these lesions. They also review management of these lesions and scenarios where US may not be definitive in diagnosis and selective use of scrotal MRI can be helpful. © RSNA, 2023 Quiz questions for this article are available in the supplemental material.
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Affiliation(s)
- Helena Gabriel
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Nancy A Hammond
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Rocio A Marquez
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Camila Lopes Vendrami
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Jeanne M Horowitz
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - David D Casalino
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Paul Nikolaidis
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Frank H Miller
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
| | - Shweta Bhatt
- From the Department of Radiology, Northwestern University, 676 N St. Clair St, Suite 800, Chicago, IL 60611 (H.G., N.A.H., R.A.M., C.L.V., J.M.H., D.D.C., P.N., F.H.M.); and Department of Radiology, Mayo Clinic, Jacksonville, Fla (S.B.)
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Al Tamr WJ, Omran K, Prashan R, al Pooja A. Management of a very rare case of polyorchidism: a case report. ANNALS OF PEDIATRIC SURGERY 2023. [DOI: 10.1186/s43159-023-00245-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Abstract
Background
Polyorchidism is a rare genetic anomaly characterized by the patient having more than two testicles. In the literature, only around two hundred cases have been reported. We present an unusual new case which does not conform to the traditional classifications of polyorchidism or previously reported cases. We discuss our diagnostic techniques as well as management decisions for this case and aim to raise awareness about the management choices available.
Case report
A 3-year-old male presented to the clinic by his parents due to concern of a painless swelling in the left inguinal region. Physical examination revealed features of a left indirect inguinal hernia. Furthermore, scrotal examination revealed a firm, non-compressible painless mass in the left scrotum which was inferior to the left testis. Ultrasonography suggested the mass as an extra testis, and MRI was followed which showed no signs of malignancy. Due to the reassuring nature of these findings, a conservative approach was taken, with the patient referred for regular follow-up.
Conclusion
When facing cases of polyorchidism, physicians should move away from considering surgical excision and biopsy as exclusive first-line management. Instead, we place emphasize and raise awareness about the option of conservative management if imaging shows no abnormalities. Ultimately, the aim of this paper is to raise awareness among the paediatric surgeon community that while excision may be a valid option, it is not the only treatment.
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Polyorchidism: An Up-to-Date Systematic Review. J Clin Med 2023; 12:jcm12020649. [PMID: 36675578 PMCID: PMC9863743 DOI: 10.3390/jcm12020649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/14/2023] Open
Abstract
Polyorchidism is a rare male urogenital tract anomaly characterized by at least one supernumerary testis in the scrotum or ectopically. According to data based on our systematic review, 76% of the supernumerary testes (SNTs) were located in the scrotum, and 24% were extra-scrotal (p < 0.001). Among testes located outside the scrotum, 87% were found in the inguinal canal and 13% in the abdominal cavity. In 80% of cases, the diagnosis of SNT was made based on imaging tests, and the remaining 20% of cases were detected incidentally during surgery. The imaging tests performed (US or MRI) resulted in a significantly higher rate of patients who qualified for observation vs. surgical treatment (45% vs. 35%, p < 0.001). The most common conditions associated with SNT were ipsilateral inguinal hernia (15% of cases) and cryptorchidism (15% of cases). Surgery (orchidopexy/orchidectomy) was performed on 54% of patients with SNT, and the decision to observe the SNT was made in a total of 46% of patients (p = 0.001). The therapeutic approach depends on the location of the SNT and the presence of factors that raise suspicion of neoplastic proliferation.
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Lohr BR, Lieske DE, Parry NM. Polyorchidism in a cat. J Vet Diagn Invest 2022; 34:1020-1022. [PMID: 36184931 PMCID: PMC9597336 DOI: 10.1177/10406387221127883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
A 9-mo-old, male domestic shorthair cat was presented for castration because of mounting behavior observed by the owner. On physical examination, the cat was bilaterally cryptorchid, but had penile spines. Abdominal exploration through a midline laparotomy revealed 2 pairs of masses. All 4 masses had gross features of testes, and ranged from 7 × 5 × 5 mm to 12 × 6 × 7 mm, with associated epididymal tissue. Histologically, each mass contained seminiferous tubules consistent with testicular tissue, and epididymal tubules, confirming a diagnosis of polyorchidism; deferent ducts were not found. There was no evidence of neoplastic, infectious, or inflammatory disease. Mounting behavior ceased 4 wk post-surgery. Histologic confirmation of more than 2 testes is needed to establish a diagnosis of polyorchidism, a rare congenital anomaly that has been reported infrequently in the veterinary literature; reports have been of animals with triorchidism, with the exception of 1 cat with 4 intraabdominal testes. Our report emphasizes that, although rare, polyorchidism should be considered in cryptorchid cats, or whenever penile spines are present in a previously castrated cat. Our case also highlights the value of checking for penile spines in a bilaterally cryptorchid cat if abdominal ultrasound is not an option to aid in surgical planning.
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Li M, Li J, Li F, Peng Q. Polyorchidism: A rare case of four testes. Asian J Surg 2022; 46:1656-1657. [PMID: 36210307 DOI: 10.1016/j.asjsur.2022.09.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/22/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Maoxian Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan Province, China
| | - Jinfeng Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan Province, China
| | - Fulin Li
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan Province, China
| | - Qiang Peng
- Department of Pediatric Surgery, Chengdu Women's and Children's Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, 611731, Sichuan Province, China.
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Pickett L, Davis N, Quinlan M. A case of supernumerary testis. BJR Case Rep 2022; 8:20220068. [PMID: 36211604 PMCID: PMC9518732 DOI: 10.1259/bjrcr.20220068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 06/29/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
Abstract
Polyorchidism is a rare congenital anomaly which describes the presence of more than two intra- or extrascrotal testes. Typically, the supernumerary testis is found incidentally during surgery for another condition but may present clinically as a painless paratesticular mass necessitating a radiological diagnosis. Polyorchidism carries an increased risk of testicular malignancy, with cryptorchidism the likely most important risk factor. Given, however, that the supernumerary testis likely contributes a reproductive function, surgical removal and definitive histopathological diagnosis is not always appropriate. We present a radiologically diagnosed supernumerary testis in a 40-year-old male with a history of surgically managed cryptorchidism in childhood.
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Affiliation(s)
| | | | - Mark Quinlan
- Connolly Hospital, Blanchardstown, Dublin, Ireland
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13
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Microsurgical Excision of a Supernumerary Testis: A Novel Technique to Avoid Iatrogenic Injury to the Adjacent Testis. Urology 2022; 169:241-244. [PMID: 35809702 DOI: 10.1016/j.urology.2022.06.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 06/26/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION In this report, we discuss the evaluation of a patient with chronic scrotal pain found to have a supernumerary testis (SNT), as well as a novel microsurgical approach to safely removing this testis. TECHNICAL CONSIDERATIONS To avoid any iatrogenic injury to the adjacent testis, we used an operating microscope to visualize the cord structures of both testes and carefully remove the smaller, atrophic, supernumerary testis. The surgery was successfully completed without any intraoperative or postoperative complications. Total operative time was 2 hours. While the patient had not yet attempted to conceive at the time of follow-up, given our careful dissection, we expect him to have normal testicular function and fertility in the future. CONCLUSION This case demonstrates a novel microsurgical approach to excising a supernumerary testis that avoids injury to the blood supply, epididymis, and vas deferens associated with the normal testis.
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14
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Hakimi T, Rezavi F, Farook MI, Jawed MA. Polyorchidism presenting as cryptorchidism. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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15
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Ojaghzadeh D, Naji P, Ensannezhad A, Mahmoudpour M, Jalili J, Hakimzadeh Z. Pentaorchidism diagnosed on ultrasound examination: A case report and literature review. Andrologia 2022; 54:e14389. [PMID: 35122296 DOI: 10.1111/and.14389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Revised: 01/07/2022] [Accepted: 01/09/2022] [Indexed: 11/27/2022] Open
Abstract
Polyorchidism is a congenital malformation of the urogenital system that is usually found incidentally in adolescent age groups. Ultrasound and MRI are effective non-invasive diagnostic modalities which can differentiate this condition from other intrascrotal pathologies. Ultrasonography is mostly used in initial steps of diagnostic approach; however, MRI is considered as a modality to confirm diagnosis and evaluate possible malignancy. We report an extremely rare case of pentaorchidism (five testicles), presented with a left hemiscrotum mass. Diagnosis was made based on physical examination, laboratory analysis (testicular germ cell tumour markers and semen analysis) and imaging. Finally, close surveillance with ultrasound and physical examination was recommended for follow-up of this uncomplicated patient.
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Affiliation(s)
| | - Pourya Naji
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | | | - Javad Jalili
- Department of Radiology, Emam Reza Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Zahra Hakimzadeh
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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16
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Xiaofei L, Benzhang Z. Case Report: Testicular Torsion in Unilateral Supernumerary Testis. Front Pediatr 2022; 10:823374. [PMID: 35479762 PMCID: PMC9035904 DOI: 10.3389/fped.2022.823374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 02/14/2022] [Indexed: 11/13/2022] Open
Abstract
Supernumerary testis (SNT), or polyorchidism, is a rare congenital anomaly of the genitourinary tract, described as the presence of more than two testicles. Testicular torsion (TT) in unilateral SNT is extremely rare. We report a case of unilateral SNT in a 16-year-old boy accompanied by TT, which was diagnosed preoperatively based on the outcomes of physical examination and ultrasound and confirmed intraoperatively. We opted for orchiectomy of this SNT because of the long-time hypoperfusion. And as for the normal testis, orchidopexy was performed. His clinical presentation subsided after surgery, and the patient was discharged 3 days later.
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Affiliation(s)
- Lu Xiaofei
- Department of Urology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Zhou Benzhang
- Department of Urology, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
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17
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Assefa HG, Erge MG, Gebreselassie HA. Triorchidism, a Rare Genitourinary Anomaly: A Case Series. Res Rep Urol 2021; 13:549-552. [PMID: 34368020 PMCID: PMC8336984 DOI: 10.2147/rru.s323558] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 07/16/2021] [Indexed: 11/29/2022] Open
Abstract
Triorchidism is the most common type of polyorchidism. In general, polyorchidism is a rare congenital anomaly that has been reported in around two hundred cases to date. We report a case series on 5- and 12-year-old boys that visited our hospital for undescended testis, and during intervention, triorchidism was found incidentally. This case series offers brief discussion on polyorchidism and its management principles ascribed in different literatures.
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Affiliation(s)
- Hiwote G Assefa
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Maru Gama Erge
- Department of Surgery, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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18
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Supernumerary testicle presented as an extra scrotal lump. J Ultrasound 2021; 25:403-407. [PMID: 34050915 DOI: 10.1007/s40477-021-00592-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 10/21/2022] Open
Abstract
A 28-year-old patient was admitted to radiology department due to a painless left-sided extra scrotal lump and discomfort in the ipsilateral lower inguinal region. Scrotal ultrasound revealed an oval circumscribed soft tissue mass, located in the proximity of the distal part of spermatic cord, without visible flow at Color Doppler. Scrotal MRI depicted T2 hyperintense, T1 hypo- to isointense oval mass with diffusion restriction and no fat suppression, surrounded by T1/T2 hypointense rim, located close to the spermatic cord. Additionally, MRI revealed coma-shaped T1 iso-/T2 hypointense related to the testicle formation. Following the intravenous administration of gadolinium-based contrast agent, both previously described structures enhanced. Taking into account that malignancy could be the potential complication of polyorchidism our patient was operated and histopathology confirmed supernumerary testicle with cribriform epididymal hyperplasia.
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19
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Mazketly M, Aleter O, Brimo Alsaman MZ, Bazkke B, Jouda ME, Kayyali A. A rare case of polyorchidism in a 40-year-old man. A case report. Ann Med Surg (Lond) 2021; 66:102389. [PMID: 34040773 PMCID: PMC8144338 DOI: 10.1016/j.amsu.2021.102389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/04/2021] [Accepted: 05/08/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction and importance Polyorchidism is defined as the presence of three testes or more. Approximately, there are about 200 cases of polyorchidism in the medical literature. In the past, surgical treatment was done but now with imaging studies, less aggressive approach is recommended. Here we present a case of 40-year-old man who was diagnosed incidentally with polyorchidism in the right hemiscrotum which is quite unusual in this age. Case presentation A 40-year-old man presented to the emergency department with a swelling and pain in the left hemiscrotum. In palpation, we noticed a scrotal mass in the right hemiscrotum. His parents had first noticed a scrotal mass when he was two years old and was incorrectly diagnosed as hydrocele by an unauthorized practitioner. In the left hemiscrotum, Doppler confirmed acute epididymitis diagnosis that was treated conservatively with antibiotics and NSAIDs. In the right hemiscrotum, MRI showed that the lump had separate epididymis and shared a common vas deferens with the right testis, which confirmed the diagnosis of supernumerary testis and the patient underwent a follow-up ultrasound after a month and after six months of his presentation. Discussion Triorchidism is the most common type of polyorchidism. Polyorchidism is diagnosed incidentally hence it is asymptomatic. There are many types of Polyorchidism and tow classification have been described. When the patient is asymptomatic the concentrative treatment is recommended. Conclusion Polyorchidism is a rare congenital anomaly in the genitourinary tract. It is diagnosed incidentally. Ultrasound or MRI are used to diagnose polyorchidism cases. This Case Report is about a rare condition (polyorchidism) in a 40-year-old man which is very unusual in this age. Diagnosis has been made by imaging studies only. No need for aggressive treatment in uncomplicated cases. This case report provided a brief review about the classification of Polyorchidism and other differential diagnosis.
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Affiliation(s)
| | - Owais Aleter
- Radiology Department, Aleppo University Hospital, Aleppo, Syria
| | | | - Bashar Bazkke
- Faculty of Medicine, University of Aleppo, Aleppo, Syria
| | | | - Alae Kayyali
- Radiology Department, Aleppo University Hospital, Aleppo, Syria
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20
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Rafailidis V, Huang DY, Sidhu PS. Paratesticular lesions: Aetiology and appearances on ultrasound. Andrology 2021; 9:1383-1394. [PMID: 33864338 DOI: 10.1111/andr.13021] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 04/12/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ultrasound (US) is the primary modality for the investigation of scrotal pathology, including both intra- and paratesticular abnormalities. OBJECTIVE To describe the abnormalities of the paratesticular space. MATERIALS/METHODS The paratesticular space contains the epididymis, spermatic cord and the tunica vaginalis cavity and is affected by a variety of inflammatory or tumoral entities. Differential diagnosis based on US criteria is frequently problematic, as the findings are non-specific. RESULTS Some general rules apply: (i) unlike testicular lesions, extra-testicular entities are usually benign in the adult, (ii) the first steps to accurate diagnosis include careful localization of the lesion and assessment of its consistency (solid or cystic) and (iii) magnetic resonance imaging can be useful for further tissue characterization of lesions suspected to contain fat, but surgical biopsy will often provide the definite diagnosis. Contrast-enhanced ultrasound (CEUS) has been applied with limited experience indicating a narrow role, primarily for the differential diagnosis of echogenic cystic entities and the delineation of a necrotic abscess from a solid neoplasm. DISCUSSION The various abnormalities are discussed and illustrated. CONCLUSION This manuscript summarizes the literature on paratesticular lesions and the value of US in diagnosis.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Dean Y Huang
- Department of Radiology, King's College London, King's College Hospital, London, UK
| | - Paul S Sidhu
- Department of Radiology, King's College London, King's College Hospital, London, UK
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21
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Supernumerary Testis Discovered Upon Workup of a Paratesticular Mass. Urology 2021; 156:e144-e146. [PMID: 33865862 DOI: 10.1016/j.urology.2021.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/27/2021] [Accepted: 03/30/2021] [Indexed: 10/21/2022]
Abstract
A supernumerary testis is a rare finding with limited description in the literature. Presentations of supernumerary testes vary and often involve initial discovery intraoperatively or in association with a separate condition. In this case report, we describe our experience of a patient with ultrasound imaging concerning for a left paratesticular mass. The patient was taken to the operating room where the mass was found to be an atrophic, supernumerary testis. We also address the specific anatomy encountered in our case and discuss both the intraoperative and post-operative management that resulted, in addition to reviewing relevant literature.
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22
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Aldughiman AW, El-Tholoth HS, Alsunbul A, Badawy E, Alelaiwai A. Management of polyorchidism in a prepubertal boy: A case report and literature review. Urol Ann 2021; 12:385-387. [PMID: 33776338 PMCID: PMC7992534 DOI: 10.4103/ua.ua_154_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Accepted: 07/23/2020] [Indexed: 11/04/2022] Open
Abstract
Polyorchidism is a very rare embryological anomaly characterized by the presence of extra number of testes with the usual presentation of two homolateral and one contralateral testis and no clear guidelines for management. Herein, we present a 14yearold case with left supernumerary testes presented with discomfort and painless mass, diagnosed by US and confirmed by magnetic resonance imaging. Conservative treatment was implemented, in the form of ultrasound followup imaging (every 6-12 months) with selfscrotal examination every month.
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Affiliation(s)
| | - Hossam S El-Tholoth
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrhman Alsunbul
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Elsayed Badawy
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Abdulrhman Alelaiwai
- Department of Urology, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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23
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Balawender K, Wiatr T, Wawrzyniak A, Orkisz S. Management of Incidental Finding of Triorchidism Diagnosed During Routine Hernia Repair. Res Rep Urol 2021; 13:127-131. [PMID: 33708748 PMCID: PMC7943550 DOI: 10.2147/rru.s291621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/20/2021] [Indexed: 11/23/2022] Open
Abstract
Polyorchidism is a rare congenital anomaly which refers to the presence of more than two intra- or extrascrotal testicles. Triorchidism, the presence of one extra testicle is the most common type. This report describes the case of a 29-year-old male who was found to have a right supernumerary undescended testis encountered incidentally during hernia repair. With this in mind, the current knowledge of management of supernumerary testis was analysed, including potential scenarios, to delineate what a urologist should do when a supernumerary testis is found during routine surgical procedures such as orchidopexy or hernia repair.
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Affiliation(s)
- Krzysztof Balawender
- Department of Urology and Urological Oncology, Municipal Hospital in Rzeszow, Rzeszow, Poland.,Morphological Sciences Department of Human Anatomy, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Tomasz Wiatr
- Jagiellonian University Medical College, Department of Urology, Cracow, Poland
| | - Agata Wawrzyniak
- Morphological Sciences Department of Human Anatomy, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
| | - Stanisław Orkisz
- Morphological Sciences Department of Human Anatomy, Institute of Medical Sciences, Medical College of Rzeszow University, Rzeszow, Poland
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24
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Roy J, Hunt J, Ecclestone H, Johnston J. Three's a crowd: A very rare form of polyorchidism with sertoli cell adenomas. Urol Case Rep 2020; 34:101512. [PMID: 33318937 PMCID: PMC7726671 DOI: 10.1016/j.eucr.2020.101512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 11/25/2020] [Accepted: 11/28/2020] [Indexed: 11/01/2022] Open
Abstract
Polyorchidism is rare with fewer than 200 cases reported in literature. We present a case of a 26 year old male with chronic pain secondary to a very rare form of polyorchidism, with histology showing Sertoli cell adenomas. Orchiectomy should be considered in patients with chronic pain due to polyorchidism.
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Affiliation(s)
- James Roy
- Taranaki Base Hospital, Taranaki District Health Board, 23 David Street, New Plymouth, New Zealand
| | - James Hunt
- Taranaki Pathology Services, 56 Vivan Street, New Plymouth, New Zealand
| | - Hazel Ecclestone
- Taranaki Base Hospital, Taranaki District Health Board, 23 David Street, New Plymouth, New Zealand
| | - James Johnston
- Taranaki Base Hospital, Taranaki District Health Board, 23 David Street, New Plymouth, New Zealand
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25
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Bayissa BB, Tesfaye D. Triorchidism; an incidental finding at inguinal hernia repair: A case report. Int J Surg Case Rep 2020; 77:813-815. [PMID: 33395902 PMCID: PMC7724094 DOI: 10.1016/j.ijscr.2020.11.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 11/22/2020] [Accepted: 11/22/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Polyorchidism is a rare congenital malformation with about 200 cases reported in literatures. Triorchidism and left side occurrence are the most common presentation. This case report was aimed to report the rare presentation of polyorchidism which was on the right side and along with incarcerated inguinal that make it by far the least encountered presentation. The intraoperative management for the polyorchidism was an issue of dilemma but adult type can be excised safely. PRESENTATION OF THE CASE A 43 year old farmer presented with right side inguino-scrotal mass and recent failure to reduce to abdomen. He used to have pain lower abdominal pain with slight pressure since childhood but didn't get any medical evaluation. He has completed his family number and didn't complain any sexual problem. Physical examination showed that there was non-tender irreducible soft right side inguino-scrotal mass. The right side testis was not appreciated. DISCUSSION Triorchidism is one of the commonly occurring variant of supernumerary testes that diagnosed incidentally during investigations or interventions for other pathologies. Incarcerated inguinal hernia masks its detection on physical examinations, so its diagnosis is more of intraoperative making a one time management for both pathologies at single operation especially if the operation undertake with general anesthesia. This patient was operated for incarcerated inguinal hernia with incidental finding of right side type B1 polyorchidism. Both of the right side testes were atrophic and excision was done. CONCLUSION Patients who present at a late adulthood age with polyorchidism and undescended testis can be successfully treated with surgical removal of the atrophic supernumerary testes.
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Affiliation(s)
- Badhaasaa B Bayissa
- Haramaya University, College of Health and Medical Sciences, Department of Surgery, Ethiopia.
| | - Dhugasa Tesfaye
- Oromia Regional Health Bureau, Shambo General Hospital, Ethiopia
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26
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Betancourt-Torres M, Figueroa-Diaz L, Rodriguez-Mojica W. Paratesticular Dermoid Cyst Mimicking a Torsed Supernumerary Testis: A Case Report. AMERICAN JOURNAL OF CASE REPORTS 2020; 21:e923752. [PMID: 33070146 PMCID: PMC7582465 DOI: 10.12659/ajcr.923752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Patient: Male, 8-year-old Final Diagnosis: Dermoid cyst Symptoms: Pain Medication: — Clinical Procedure: Ultrasonography Specialty: Radiology
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Affiliation(s)
| | - Laura Figueroa-Diaz
- Department of Diagnostic Radiology, University of Puerto Rico, San Juan, Puerto Rico
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27
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Sentinel nubbin: A potential pitfall in the management of undescended testis secondary to epididymo-testicular nonunion. J Pediatr Urol 2020; 16:635.e1-635.e7. [PMID: 32891575 DOI: 10.1016/j.jpurol.2020.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/11/2020] [Accepted: 08/14/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Epididymal anomalies are common in boys with undescended testis. Epididymo-testicular non-union with a nubbin in the scrotum is a rare anomaly and may be confusing during management of cryptorchidism. The non-fused epididymis and vas deferens which are descended to the scrotum, may be regarded as nubbin tissue secondary to testicular atrophy and proximal testis may be overlooked. OBJECTIVE To evaluate a relatively rare anomaly of epididymo-testicular non-union in which vas deferens and epididymis are descended to the scrotum resembling a nubbin tissue, while a separate testis remains in a proximal peritoneal fold (hernia or processus vaginalis)which could potentially be missed during the management of patients with undescended testis. STUDY DESIGN The charts of the fourteen patients with epididymo-testicular non-union and a scrotal nubbin are retrospectively evaluated. RESULTS Median age of the patiens was 1.5 years (0.5-12), 11 were left and 3 were right. No connection could be demonstrated between the testis and vaso-epididymal unit in any of the patients. Orchidopexy was performed in 13 patients while orchidectomy in1 patient. The scrotal nubbin tissue is excised in 4 patients and histological examination revealed sections of vas deferens and epididymis. One of the patients underwent inguinal exploration and orchidectomy for assumed testicular atrophy elsewhere but histological examination revealed vas deferens and epididymis without any sign suggesting an atrophic testis. An intrabdominal testis was found incidentally in this patient and he underwent 2 additional procedures for orchidopexy. DISCUSSION Although epididymo-testicular anomalies are common in boys with undescended testis, nonunion is the rarest type of this anomaly. Similar cases are reported in the literature as simple fusion anomalies with indefinite clinical significance or even polyorchidism although no accessory testis could be demonstrated. However, the scrotal nubbin tissue which actually contains epididymis and vas is a potential decoy and may result in missing of the proximal testis if regarded as a sign of testicular atrophy and further evaluation is obviated. As this is retrospective study, actual incidence of the condition is yet to be determined. CONCLUSION A scrotal nubbin tissue may be secondary to epididymo-testicular nonunion as well as testicular atrophy. As feasibility of radiological imaging studies are limited, a laparoscopic exploration may be considered to confirm or to exclude a separate testis in patients with scrotal nubbin. Prospective studies are needed to evaluate the actual incidence of the condition and gain-loss analysis of laparoscopic exploration.
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Triorchidism: Unilateral double atrophic undescended testis in Tertiary Specialized Hospital, Ethiopia. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2020. [DOI: 10.1016/j.epsc.2020.101633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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29
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Ojaghzadeh D, Mahmoudpour M, Ezzati N, Akhavi Milani A. Polyorchidism in ultrasound examination: A case report. Andrologia 2020; 53:e13832. [PMID: 32897591 DOI: 10.1111/and.13832] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 08/16/2020] [Indexed: 11/30/2022] Open
Abstract
Polyorchidism is usually diagnosed incidentally when the patient undergoes imaging or surgery for some other reason. Although we are facing lack of evidence in different steps of diagnostic and therapeutic workup of these patients, this disorder is usually considered benign, not requiring any intervention. We report the case of a man complaining of a palpable mass in his scrotum. We evaluated the patient using ultrasound, MRI and serum tumour marker level measurement. The patient was finally diagnosed with polyorchidism (three testes). For the management, we recommended annual physical examination, US examination and serum tumour marker level measurement.
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Affiliation(s)
| | | | | | - Ali Akhavi Milani
- Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
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30
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Santos LRD, Duarte ML, Duarte ÉR, Figueiras FN. Polyorquidism: case report comparing ultrasonography and magnetic resonance imaging. REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000300013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Abstract Introduction: polyorchidism is an unusual pathology, about 200 cases in the world literature. Case report: we reported a case of polyorchidism in a 16-year-old male patient diagnosed by ultrasound and confirmed by magnetic resonance imaging. Discussion: most of the cases presented, there is a supernumerary testis, but there are reports on more than three, up to five testicles with supranumerical gonads on both sides of the scrotum. The diagnosis is usually performed in late puberty, incidentally, with a painless scrotal mass or at the emergency room, presenting a testicular torsion of the whole hemiscrotum or supernumerary testisalone, and the differential diagnosis should be made with epididymal cyst and spermatocele, besides other extra-testicular masses (hydroceles, varicoceles, lipomas, tumors.) and para-testicular masses (hernias, scrotal calculi). After the initial clinical evaluation, ultrasound is the first line subsidiary exam. Magnetic Resonance Imaging is very helpful, just in case the ultrasound diagnosis is uncertain. The supernumerary testishave the same Magnetic Resonance Imaging characteristics as the normal testes (intermediate signal intensity on T1- weighted images and high signal intensity on T2-weighted images).
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31
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Zahirian Moghadam T, Mohseni Rad H, Zandian H, Hosseinkhani A. Five testicles in the genital area of a thirteen-month-old baby: a case report. BMC Urol 2020; 20:128. [PMID: 32819440 PMCID: PMC7439670 DOI: 10.1186/s12894-020-00681-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Accepted: 07/22/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Polyorchidism is a congenital anomaly of the urogenital system and means more than two testes. It is a rare phenomenon, where there are no more than 200 reported cases in the literature. In this case, we report a 13-month year's old case with five testicles. CASE PRESENTATION We report a rare five testicles in the genital area of a 13-month-old baby. The initial diagnosis was undescended testis (UDT) based on ultrasound findings where a testis in the abdomen and a testis in the inguinal canal were detected. Surgery with general anaesthesia was performed to diagnose and treat this case. Before surgery, four HCG 1200u injections were administered. During the operation, it was determined that the case had had five testicles. Testicles were on the left in the proximal inguinal canal, and the sac hernia was ligated parallel to the inner ring. The patient was followed up several times after surgery by a urologist, and the results showed that there were no problems, and the intervention was uncomplicated. CONCLUSION Based on the result, it is not possible to diagnose such cases only by examination or ultrasound in infant patients, as the patient often presents with undescended testis (UDT), so the disease is diagnosed only through surgery.
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Affiliation(s)
- Telma Zahirian Moghadam
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Mohseni Rad
- Department of Surgery, School of Medicine and Allied Medical Sciences, Imam Reza Hospital, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Hamed Zandian
- Social Determinants of Health Research Center, Ardabil University of Medical Sciences, Ardabil, Iran
| | - Ali Hosseinkhani
- Department of Surgery, School of Medicine and Allied Medical Sciences, Imam Reza Hospital, Ardabil University of Medical Sciences, Ardabil, Iran.
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32
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Mandalia U, Pakdemirli E. A case of triorchidism. Radiol Case Rep 2020; 15:1643-1645. [PMID: 32695249 PMCID: PMC7364122 DOI: 10.1016/j.radcr.2020.06.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 06/07/2020] [Accepted: 06/12/2020] [Indexed: 11/24/2022] Open
Abstract
We present the case of an adolescent male who presented with a painless left scrotal lump. Investigations revealed a diagnosis of a supernumerary testicle or polyorchidism. In this case report we discuss the imaging findings of polyorchidism on different modalities. We examine how imaging can be used to diagnose and classify this condition. We also discuss the associated complications and the role of imaging in surveillance and management of this rare disorder.
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Affiliation(s)
- Uday Mandalia
- Watford General Hospital, Vicarage Rd, Watford WD18 0HB, United Kingdom
| | - Emre Pakdemirli
- Watford General Hospital, Vicarage Rd, Watford WD18 0HB, United Kingdom
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Mittal PG, Peters NJ, Malik MA, Samujh R. Intraoperative Dilemmas in Polyorchidism: To Pex or not to Pex!! J Indian Assoc Pediatr Surg 2020; 25:175-177. [PMID: 32581447 PMCID: PMC7302454 DOI: 10.4103/jiaps.jiaps_74_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 05/29/2019] [Accepted: 06/29/2019] [Indexed: 11/04/2022] Open
Abstract
Supernumerary testis or polyorchidism is a rare congenital anomaly. It is often associated with processus vaginalis anomalies and with increased risk of malignancy and infertility. The approach to management has changed over time, with improvements in imaging techniques allowing surveillance to replace surgical excision or exploration and biopsy. In this study, two patients were managed with orchidopexy and have had a close follow-up of 2 years.
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Affiliation(s)
- Priyanka Garg Mittal
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Nitin James Peters
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Muneer Abas Malik
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ram Samujh
- Department of Pediatric Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Hirata Y, Moriya K, Nakamura M, Kon M, Nishimura Y, Ujihashi K, Higuchi M, Matsumoto R, Kitta T, Shinohara N. [PUBERTAL TESTICULAR TORSION OF POLYORCHIDISM DIAGNOSED IN INFANCY: A CASE REPORT]. Nihon Hinyokika Gakkai Zasshi 2020; 111:53-57. [PMID: 33883360 DOI: 10.5980/jpnjurol.111.53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Left polyorchidism was found in a 2-month-old boy with a left scrotal mass. As he was asymptomatic and all testes were in the scrotum, he was conservatively followed up. At 17 years of age, he presented with left acute scrotum due to testicular torsion of the left supernumerary testis. Counterclockwise 720-degree rotation of the left supernumerary testis was noted during emergency surgery, and orchidopexy of the 3 testes (2 left testes and 1 right testis) was performed. Biopsy of the left supernumerary testis demonstrated spermatogenesis and no malignancy. One and a half years after surgery, all testes were viable without atrophy.Polyorchidism is a rare condition and there is no consensus on the management of asymptomatic cases detected early in life. The position of the supernumerary testis (intrascrotal or extrascrotal) is important when deciding the management strategy because of the risk of malignancy. If conservative management is selected initially, elective surgery, such as prophylactic orchiectomy or orchidopexy, may be needed because of the risk of malignancy and torsion.
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Affiliation(s)
- Yurie Hirata
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Kimihiko Moriya
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Michiko Nakamura
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Masafumi Kon
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Yoko Nishimura
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Kazuhiro Ujihashi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Madoka Higuchi
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Ryuji Matsumoto
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Takeya Kitta
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
| | - Nobuo Shinohara
- Department of Renal and Genitourinary Surgery, Graduate School of Medicine, Hokkaido University
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Su JS, Farber NJ, Feldman MK, Vij SC. Sperm granuloma masquerading as a supernumerary testis. Urol Case Rep 2019; 29:101080. [PMID: 31867216 PMCID: PMC6906707 DOI: 10.1016/j.eucr.2019.101080] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/21/2019] [Accepted: 11/22/2019] [Indexed: 01/25/2023] Open
Abstract
Sperm granuloma is a common finding following vasectomy, with majority of the lesions located at the site of the vasectomy defect. Sperm granulomas are typically small and asymptomatic. We describe a case in which the nodule presented similarly to a supernumerary testis by radiographic features.
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Affiliation(s)
- Johnny S. Su
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
- Corresponding author. Glickman Urological and Kidney Institute, Cleveland Clinic 9500 Euclid Avenue, Q10, Cleveland, OH, 44195, USA.
| | - Nicholas J. Farber
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Myra K. Feldman
- Imaging Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Sarah C. Vij
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
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Schafer ES. The Sonographic Appearance of Polyorchidism: A Multiple Case Report. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319857987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The traditional sonographic characteristic used to distinguish polyorchidism (PO) has been its homogeneous echotexture, which is similar or identical to the normal testicle. PO is most commonly found in the left hemi-scrotum but can also be identified in the right hemi-scrotum, inguinal canal, or abdominal cavity. The mediastinum of a testicle represents where the tunica vaginalis and tunica albuginea that encases a testicle folded back in on itself. The identification of a mediastinum in a scrotal lesion implies that testicular tissue is present. This series review presents three cases where PO was identified in the left hemi-scrotum. In addition to the classic homogeneous echotexture that is typically identified in an accessory testicle, a mediastinum was also appreciated in two of the cases, which helped to solidify the diagnosis of polyorchidism.
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Affiliation(s)
- Eric S. Schafer
- Division of Ultrasound, University of Colorado Hospital, UCHealth, Aurora, CO, USA
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37
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Falah SQ. POLYORCHIDISM DISCOVERED AS AN INCIDENTAL FINDING IN 16 YEARS BOY DURING LEFT INGUINAL HERNIOTOMY. GOMAL JOURNAL OF MEDICAL SCIENCES 2019. [DOI: 10.46903/gjms/17.02.2035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
A 16 years old boy presented with three months history of left inguinal hernia. On examination, he had two normal testicles in scrotum, one on either side. During left inguinal exploration for hernia repair, a third undescended testicle was found incidentally, which was excised.
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38
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Koraş Ö, Aydın ME, Bozkurt İH, Aydoğdu Ö, Yonguç T, Yarımoğlu S. Poliorşidizm olgusu: aksesuar testiste mikrokalsifikasyon. CUKUROVA MEDICAL JOURNAL 2018. [DOI: 10.17826/cumj.350202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Boussaffa H, Naouar S, Ati N, Amri M, Ben Khelifa B, Salem B, El Kamel R. Neoplasm of a supernumerary undescended testis: A case report and review of the literature. Int J Surg Case Rep 2018; 53:345-347. [PMID: 30471627 PMCID: PMC6260374 DOI: 10.1016/j.ijscr.2018.10.082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Accepted: 10/30/2018] [Indexed: 11/29/2022] Open
Abstract
Polyorchidism is a rare congenital abnormality. To the best of our knowledge, this is the first report of leiomyoma in supranumerary testis (SNT). Most cases of polyorchidism are found incidentally during surgery for inguinal hernia, undescended testes, torsion or testicular tumor. There is no consensus regarding the management of SNT. If the SNT is scrotal, most authors recommend conservative management. If nonscrotal SNT is found incidentally during surgery, orchiectomy could be performed because of increased risk of malignancy. Treatment of intratubular germ cell neoplasia includes surveillance, orchiectomy, or low-dose external radiation.
Introduction Polyorchidism, defined as the presence of more than two testicles, is a rare congenital abnormality of the male genital tract. There is no consensus regarding the management of supranumerary testis (SNT) due to its rareness. To the best of our knowledge, this is the first report of leiomyoma in SNT. Presentation of case We report the case of a 41-year-old man with two right testes sharing a common vas deferens and separate epididymides. Orchiectomy of right testes was performed. Pathology examination found that the superior testis was the site of a leiomyoma and the lower tesits was the site of an intratubular germ cell neoplasia (IGCN). Orchiopexy and biopsy were later performed for the left testis. Histology was compatible with IGCN. We opted for follow-up to avoid risks of hypogonadism. Discussion Polyorchidism is usually asymptomatic and found incidentally during surgery for inguinal hernia, undescended testes as in our case, torsion, hydrocele or testicular tumor. If the SNT is scrotal, and there is no other indication for surgery, most authors recommend conservative management with regular ultrasound follow-up. If nonscrotal SNT is found incidentally during surgery, orchiectomy could be performed because of increased risk of malignancy. Treatment of IGCN includes surveillance, orchiectomy, or low-dose external radiation. Conclusion Different factors come into account for polyorchidsm management: the drainage system, the fertile potential of the supernumerary gonad, and its localization. In cases of uncomplicated polyorchidism, a conservative treatment, with US or MRI follow-up seems to be a rational choice without surgical complications.
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Affiliation(s)
- Hamza Boussaffa
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia.
| | - Sahbi Naouar
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Nidhal Ati
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Mohamed Amri
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | | | - Braiek Salem
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
| | - Rafik El Kamel
- Urology Department, Ibn El Jazzar Teaching Hospital, Kairouan, Tunisia
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Kealey J, Yao HH, Grummet J. Acute scrotum – Torsion of the third testicle! Urol Case Rep 2018; 20:92-93. [PMID: 30101075 PMCID: PMC6073074 DOI: 10.1016/j.eucr.2018.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 07/10/2018] [Indexed: 11/30/2022] Open
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Mittal PK, Abdalla AS, Chatterjee A, Baumgarten DA, Harri PA, Patel J, Moreno CC, Gabriel H, Miller FH. Spectrum of Extratesticular and Testicular Pathologic Conditions at Scrotal MR Imaging. Radiographics 2018; 38:806-830. [DOI: 10.1148/rg.2018170150] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Pardeep K. Mittal
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Ahmed S. Abdalla
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Argha Chatterjee
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Deborah A. Baumgarten
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Peter A. Harri
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Jay Patel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Courtney C. Moreno
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Helena Gabriel
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
| | - Frank H. Miller
- From the Department of Radiology and Imaging Sciences, Emory University School of Medicine, 1364 Clifton Rd NE, Atlanta, GA 30322 (P.K.M., D.A.B., P.A.H., J.P., C.C.M.); Department of Clinical Imaging, Hamad Medical Corporation, Doha, Qatar (A.S.A.); and Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Ill (A.C., H.G., F.H.M.)
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Konrade I, Zavorikina J, Fridvalde A, Rots D, Kalere I, Strumfa I, Dambrova M, Gailite L. Novel Variant of the Androgen Receptor Gene in a Patient With Complete Androgen Insensitivity Syndrome and Polyorchidism. Front Endocrinol (Lausanne) 2018; 9:795. [PMID: 30705665 PMCID: PMC6345100 DOI: 10.3389/fendo.2018.00795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 12/18/2018] [Indexed: 11/13/2022] Open
Abstract
Introduction: Complete androgen insensitivity (CAIS) in 65-95% cases is caused by pathogenic allelic variants (mutations) in the gene encoding androgen receptor (AR gene) and is characterized by female phenotype development with a male karyotype (46, XY). Patients are usually diagnosed during puberty and undergo gonadectomy due to increased testicular germ cell tumor risk. Only a few outcomes have been reported in older individuals with postponed gonadectomy. Case presentation: A 48-year-old CAIS patient presented with polyorchidism (four testes) without gonadal malignancies. Genetic testing identified a novel allelic variant in the AR gene [c.2141T>G (p.Phe805Cys)] causing the clinical symptoms. Conclusion: We have described a unique patient with CAIS and polyorchidism without malignancies in her late 40's bearing a novel likely pathogenic variant in the AR gene.
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Affiliation(s)
- Ilze Konrade
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
- Department of Endocrinology, Riga East University Hospital, Riga, Latvia
| | - Julija Zavorikina
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | - Aija Fridvalde
- Department of Internal Medicine, Riga Stradins University, Riga, Latvia
| | - Dmitrijs Rots
- Scientific Laboratory of Molecular Genetics, Riga Stradins University, Riga, Latvia
| | - Ieva Kalere
- Department of Pharmacy, Riga Stradins University, Riga, Latvia
| | - Ilze Strumfa
- Department of Pathology, Riga Stradins University, Riga, Latvia
| | - Maija Dambrova
- Department of Human Physiology and Biochemistry, Riga Stradins University, Riga, Latvia
| | - Linda Gailite
- Scientific Laboratory of Molecular Genetics, Riga Stradins University, Riga, Latvia
- *Correspondence: Linda Gailite
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A Unique Case of Pentaorchidism. Urology 2017; 104:196-197. [DOI: 10.1016/j.urology.2017.03.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 01/21/2017] [Accepted: 03/14/2017] [Indexed: 11/22/2022]
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Balasar M, Sönmez MG, Oltulu P, Kandemir A, Kılıç M, Göğer YE, Pişkin MM. Polyorchidism; unilateral, one atrophic undescended double testicles. Urol Ann 2017; 9:208-210. [PMID: 28479781 PMCID: PMC5405673 DOI: 10.4103/0974-7796.204190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polyorchidism is a very rare genitourinary anomaly defined with the presence of more than two testicles. Polyorchidism is associated up to 40% with undescended testicles. The present report is about an incidentally detected triorchidism case with unilateral, one atrophic undescended double testicles. A 4-year-old child, diagnosed with undescended left testicle revealed during orchiopexy polyorchidism with distinct epididymis and vas deferens. Whereas one of the testicles was in regular size; the other two were atrophic. Orchiectomy was conducted on the atrophic testicle and orchiopexy to the regular size testicle. The atrophic testicle excised was referred histopathological analysis and was diagnosed as atrophic testis. The patient discharged on the first postoperative day, was considered as normal during postoperative evaluation made on the third postoperative day. Polyorchidism is a rare genitourinary abnormality, and its management is still controversial. Yet, we believe that orchiectomy is to be conducted in atrophic testicle cases.
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Affiliation(s)
- Mehmet Balasar
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Giray Sönmez
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Pembe Oltulu
- Department of Medical Pathology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Abdülkadir Kandemir
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Kılıç
- Department of Medical Pharmacology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Yunus Emre Göğer
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
| | - Mehmet Mesut Pişkin
- Department of Urology, Meram Medical Faculty, Necmettin Erbakan University, Konya, Turkey
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Rafailidis V, Arvaniti M, Rafailidis D, Sfoungaris D. Multiparametric ultrasound findings in a patient with polyorchidism. ULTRASOUND : JOURNAL OF THE BRITISH MEDICAL ULTRASOUND SOCIETY 2017; 25:177-181. [PMID: 29410694 DOI: 10.1177/1742271x16689808] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 11/20/2016] [Indexed: 11/17/2022]
Abstract
Polyorchidism is a rare condition usually incidentally discovered in young patients investigated with ultrasound for unrelated reasons. It is characterized by the presence of unilateral or, rarely, bilateral supernumerary testes which, depending on the type of polyorchidism, may have their own epididymis and vas deferens. Ultrasound, including B-mode and color Doppler technique, represents the primary imaging modality for the evaluation of scrotal diseases, including the characterization of supernumerary testes, which normally appear identical to the ipsilateral testicular parenchyma on every ultrasonographic technique performed. The role of MRI is thus limited to confirming ultrasonographic findings and excluding the presence of malignancy. Contrast-enhanced ultrasound is a recently introduced ultrasonographic technique providing detailed and sensitive visualization of the perfusion pattern of structures. It can thus be added to the conventional ultrasonographic examination in order to establish the diagnosis, negating the use of more expensive and time-consuming imaging modalities. We present a young patient with an incidentally found supernumerary testis, where new distinctive ultrasonographic findings, like the identification of transmediastinal vessels and a cystic appendage along with the perfusion pattern on contrast-enhanced ultrasound, established the diagnosis of polyorchidism.
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Affiliation(s)
- Vasileios Rafailidis
- Department of Radiology, "AHEPA" University General Hospital of Thessaloniki, Aristotle University of Thessaloniki, Greece
| | - Mary Arvaniti
- Department of Radiology, "G. GENNIMATAS" General Hospital, Thessaloniki, Greece
| | | | - Dimitrios Sfoungaris
- 1st Department of Paediatric Surgery, Aristotle University of Thessaloniki, Greece
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A Unique Case of Intraabdominal Polyorchidism: A Case Study. Case Rep Urol 2016; 2016:2729614. [PMID: 27722006 PMCID: PMC5045993 DOI: 10.1155/2016/2729614] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 05/24/2016] [Indexed: 12/03/2022] Open
Abstract
Background. Polyorchidism, alternatively supernumerary testes (SNT), is a condition where an individual is born with more than two testicles. This congenital anomaly is quite rare and the literature has described various presentations. Questions/Purposes. To our knowledge, this presentation of polyorchidism has yet to be described in the literature. The goal of this case study is to add to the pediatric, general, and urologic surgery's body of knowledge of the subject matter. Case Study. A nine-month-old boy was admitted for an impalpable right testis and phimosis. At the time of surgical exploration, there appeared to be polyorchid testis on the right-hand side, with three masses that potentially appeared to be undescended testes. Discussion. Proponents of a conservative approach argue that infertility is common in patients with polyorchidism and, by preserving a potentially functional SNT, there may be improved spermatogenesis. When performing definitive surgical treatment, meticulous intra-abdominal and intrainguinal exploration must be undertaken. Orchiopexy should be performed to reduce the chances of torsion, malignancy, and infertility. Conclusion. Our case is important to the literature as it is the first known case of polyorchidism with 3 SNT on the right side, located intra-abdominally, and in a patient less than 1 year of age.
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Uğuz S, Gürağaç A, Demirer Z, Yilmaz S, Aydur E. Bilateral polyorchidism with ipsilateral two undescended testes: a rare congenital anomaly. Andrologia 2016; 49. [PMID: 27373456 DOI: 10.1111/and.12643] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2016] [Indexed: 11/30/2022] Open
Abstract
Polyorchidism is defined as the presence of more than two testes. This rare congenital anomaly has been reported with only 140 pathologically proven cases in the published literature to date. While triorchidism is the most common variation and generally affects the left side, bilateral polyorchidism is even rare and only seven cases of patients with four testes have been reported in the literature. There is no consensus in the literature regarding the management of supernumerary testis due to its rareness. We report such a rare case of a 20-year-old male patient, who was presented with left-sided scrotal mass and right inguinal swelling and, diagnosed as polyorchidism including four distinct testes, with two of them in left hemiscrotum and the other two testes in the right inguinal canal. The patient underwent orchiopexy for the normal looking right-sided testis, and orchiectomy for the right-sided supernumerary testis being dysmorphic and potential malignancy risk. Histopathological examination confirmed the excised tissue to be severely atrophic testicle. The patient is still following with regular self-examination and scrotal ultrasonography. Polyorchidism should be keep in mind especially for the differential diagnosis of extratesticular and paratesticular masses. Physical examination may not be sufficient, and radiologic examination can provide accurate diagnosis. Conservative, extirpative or reconstructive approaches could be performed based on individual basis by reproductive potential and location of supernumerary testis, coexistence of other disorders and suspicion of malignancy.
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Affiliation(s)
- S Uğuz
- Department of Urology, School of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
| | - A Gürağaç
- Department of Urology, Tatvan Military Hospital, Bitlis, Turkey
| | - Z Demirer
- Department of Urology, Eskisehir Military Hospital, Eskisehir, Turkey
| | - S Yilmaz
- Department of Urology, School of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
| | - E Aydur
- Department of Urology, School of Medicine, Gülhane Military Medical Academy, Ankara, Turkey
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Bhandarwar AH, Gandhi SS, Patel CB, Wagh AN, Gawli V, Jain NA. Triorchidism: Presenting as Undescended Testis in a Case of Indirect Inguinal Hernia. Clin Pract 2016; 6:786. [PMID: 27478577 PMCID: PMC4943097 DOI: 10.4081/cp.2016.786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 03/24/2016] [Accepted: 03/25/2016] [Indexed: 11/23/2022] Open
Abstract
Triorchidism is the commonest variety of polyorchidism, an entity with more than two testis is an extremely rare congenital anomaly of the testis. Although excision of the abnormal testis is a safer alternative proposed, recent literature suggests more conservative approach in normal testes with watchful regular follow up to screen for malignancy. This case presented as a left inguinal swelling diagnosed as indirect left inguinal hernia. The left side testis was of smaller size (about half) with normal sperm count, morphology and motility. Intraoperatively indirect inguinal hernia was noted with supernumerary testis at deep ring in addition to normal left testis in left scrotal sac. The ectopic testis were small (2.5×2.5×1 cm) lacking epididymis and with short vas deferens. An evident normal semen analysis and varied anatomy, the decision for orchidectomy of ectopic testis was taken. The histopathological finding was consistent with arrest in germ cell development.
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Affiliation(s)
- Ajay H Bhandarwar
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Saurabh S Gandhi
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Chintan B Patel
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Amol N Wagh
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Virendra Gawli
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
| | - Nimesh A Jain
- Division of Gastrointestinal, Hepatobiliary & Pancreatic, Minimal Access, Bariatric & Metabolic Surgery, Department of Surgery, Grant Government Medical College & Sir J.J. Group of Hospitals , Byculla, Mumbai, Maharashtra, India
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Aziz W, Rehman KU, Rafique MZ. Doppler ultrasound findings in a patient with primary infertility and triorchidism. BMJ Case Rep 2016; 2016:bcr-2016-215346. [PMID: 27154988 DOI: 10.1136/bcr-2016-215346] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polyorchidism, presence of more than two testes in a scrotum, is a rare clinical entity. To date, about 200 cases have been reported in the literature. We report a case of triorchidism in a patient presenting with a 7-year history of primary infertility. Clinical examination revealed two completely separate testes with two separate epididymides and single vas suggesting a complete division of the genital ridge and partial duplication of the vas deferens. In our patient, the clinical picture together with ultrasound findings were characteristic enough to exclude other diagnoses, allowing conservative management. We also present the Doppler ultrasound findings of this rare condition, which may be helpful for comparison in patients with triorchidism who present with testicular torsion.
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