Splenogonadal fusion: a radiologic-pathologic correlation and review of the literature

The continuous type of splenogonadal fusion: A rare case report and literature review

INTRODUCTION

We report a rare case of the continuous type of splenogonadal fusion (SGF) in a young adolescent with preserved testis.

CASE PRESENTATION

A 19-year-old male patient with a history of left inguinal hernia repair 10 years ago presented with a palpable mass on the left side. Computed tomography revealed a 58x37mm mass with a tissue density of 47HU, demonstrating vigorous enhancement following contrast administration and displaying well-defined margins with the left testicle. It was noted to be growing vertically in the left inguinal canal and to be continuous with the lower pole of the native spleen. The patient underwent laparoscopic surgery to remove the splenic tail in the abdomen and to separate the scrotal spleen from the left testicle through the left inguinal tract. The histopathological examination confirmed the presence of splenic tissue.

DISCUSSION

SGF is often diagnosed incidentally during exploration or surgery for scrotal swelling or mass, cryptorchidism, or inguinal hernia in young patients. It is important to be aware of this condition to avoid unnecessary radical orchiectomy.

CONCLUSION

Diagnosing the SGF preoperatively can be challenging. However, a combination of imaging modalities and negative tests for alpha-fetoprotein (AFP), lactate dehydrogenase (LDH), and beta-human chorionic gonadotropin (b-HCG) can aid in making an initial diagnosis. The use of laparoscopic surgery can further improve the diagnostic process, allowing clinicians to accurately diagnose SGF and make well-informed treatment decisions.

A case of splenogonadal fusion in the left testis

Splenic tissue outside the normal anatomical site can be collectively referred to as ectopic spleen. Clinically, the commonest causes of ectopic spleen include accessory spleen, splenic tissue implantation, and splenogonadal fusion (SGF). Accessory spleen is mostly caused by congenital dysplasia, is mostly located near the spleen, and may be supplied by the splenic artery. Splenic implantation is mostly caused by autologous spleen tissue transplantation caused by trauma or surgery. SGF is the abnormal fusion of the spleen with the gonad or with the mesonephric derivatives. As a rare developmental malformation, it is difficult to make a correct diagnosis preoperatively, and easily misdiagnosed as a testicular tumor cause lifelong harm to patients. An 18-year-old male student who developed left testicular pain without obvious cause that radiated to the perineum 4 months prior to presentation. He was diagnosed with cryptorchidism 12 years ago and underwent orchiopexy without intraoperative frozen section examination. An ultrasound was performed, identifying hypoechoic nodules in the left testis, suggestive of seminoma. During surgery, the testicular tumor revealed a dark red tissue and the diagnosis of a pathological ectopic splenic tissue was made. Because the clinical manifestations of SGF are not specific, misdiagnosis and unnecessary orchiectomy may occur. If a complete preoperative examination which includes biopsy or intraoperative frozen section is performed, unnecessary orchiectomy can be effectively avoided and bilateral fertility can be preserved.

Splenogonadal Fusion: A Rare Mimicker of Malignancy

Splenogonadal fusion is a rare congenital anomaly in which ectopic splenic tissue is found in the testis and can present as a testicular mass mimicking a testicular malignancy. We present a 27-year-old male who presented with a palpable left testis mass suspicious for malignancy and ultimately found to have discontinuous splenogonadal fusion after radical orchiectomy.

Contrast-enhanced ultrasound of the spleen, pancreas and gallbladder in children

Gray-scale and color/power Doppler ultrasound (US) are the first-line imaging modalities to evaluate the spleen, gallbladder and pancreas in children. The increasing use of contrast-enhanced ultrasound (CEUS) as a reliable and safe method to evaluate liver lesions in the pediatric population promises potential for imaging other internal organs. Although CEUS applications of the spleen, gallbladder and pancreas have been well described in adults, they have not been fully explored in children. In this manuscript, we present an overview of the applications of CEUS for normal variants and diseases affecting the spleen, gallbladder and pancreas. We highlight a variety of cases as examples of how CEUS can serve in the diagnosis and follow-up for such diseases in children. Our discussion includes specific examination techniques; presentation of the main imaging findings in various benign and malignant lesions of the spleen, gallbladder and pancreas in children; and acknowledgment of the limitations of CEUS for these organs.