Polyorchidism: two case reports and a review of the literature

Embryological basis of polyorchidism including classification, reproductive potential, and risk of malignancy: A review

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.

Inguinal Polyorchidism Found Incidentally During Orchiopexy in 9-Year-Old Male: A Case Report and Review of Orchiopexy of Nonscrotal Supernumerary Testes

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.

Management of a very rare case of polyorchidism: a case report

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.

Polyorchidism and testicular malignancy, what can we learn: A case report

INTRODUCTION

Polyorchidism is a rare condition with a total number of approximately 190 cases. Malignancy was found in 6,4% of cases.

CASE PRESENTATION

A 57 years old man came with a sudden and persistent painful mass in right inguinal region. The patient decided to undergo surgery with diagnosis of incarserated lateral hernia inguinal and obtained a testicular-like lump in the right inguinal canal, then the patient underwent orchiectomy. Histopathological examination revealed a soft tissue tumor with microscopic characteristic of seminoma. CT-Scan revealed metastasis to lung and liver.

CONCLUSION

Attention must be given to detect malignancy in polyorchidism.

A rare case of polyorchidism in a 40-year-old man. A case report

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.

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This Case Report is about a rare condition (polyorchidism) in a 40-year-old man which is very unusual in this age.

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Diagnosis has been made by imaging studies only. No need for aggressive treatment in uncomplicated cases.

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This case report provided a brief review about the classification of Polyorchidism and other differential diagnosis.

Management of Incidental Finding of Triorchidism Diagnosed During Routine Hernia Repair

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.

Five testicles in the genital area of a thirteen-month-old baby: a case report

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.

A case of triorchidism

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.

Appendiceal fibroma in an Amyand's hernia mimicking a supernumerary testis: a case report

Amyand's hernia describes the presence of an appendix within the sac of an inguinal hernia. Both an inflamed and non-inflamed appendix within the hernia sac have been reported in the literature with various recommendations on approach to management. However, a tumour of the appendix is a rare finding in an Amyand's hernia. We hereby report the unusual presentation of a fibroma of the appendix complicating the rare Amyand's hernia in a young man with a scrotal mass.

POLYORCHIDISM DISCOVERED AS AN INCIDENTAL FINDING IN 16 YEARS BOY DURING LEFT INGUINAL HERNIOTOMY

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.

A Rare Case of Polyorchidism: Four Testes

Background

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

Case Report

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

Conclusions

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