[Unusual testicular tumor: an ectopic spleen]

Pathogenesis, Diagnosis, and Management of Splenogonadal Fusion: A Literature Review

Introduction

Splenogonadal fusion is a rare congenital anomaly, defined by the presence of ectopic splenic tissue caused by an abnormal connection between the spleen and the gonad or mesonephrotic derivatives during the embryonic period.

Materials and Methods

By reporting an observational case and performing a review of the literature according to the CARE guidelines (using the PubMed database and guidelines from urology, general surgery, and pediatric learned societies), we present the embryological genesis of the splenogonadal fusion, the associated anatomical anomalies, and the diagnostic procedure. Observation. We report the case of a patient aged 45, with no notable history, reporting left testicular pain. A small nodule on the upper pole of the left testicular was clinically palpable. Tumor markers were normal, and scrotal ultrasound depicted a hypoechoic hypervascular nodule measuring 8∗6∗8 mm. After validation in a multidisciplinary oncology consultation meeting and opinion from a uro-andrologist expert, the patient underwent an inguinal lumpectomy with an extemporaneous examination which did not objectify any signs of malignancy. Ultimately, it is a normal spleen tissue in the testicular ectopic position. Discussion. Splenogonadal fusion corresponds to a rare congenital malformation; less than 200 cases have been published in the literature, most often affecting boys, with a sex ratio of 15/1. Two types are described, depending on the continuity of the link between the orthotopic spleen and the gonad: the continuous and discontinuous forms. In a third of the cases, there are associated congenital malformations and particularly in the continuous forms (44 to 50% of the cases): anomalies of the limbs, micrognathia, microgyria, and hepatic and digestive abnormalities. Cryptorchidism is associated with the continuous form in 31% of cases. The preoperative diagnosis remains difficult because of its morphological and clinical characteristics suggesting a tumor process.

[Splenogonadal fusion: a case report]

Splenogonadal fusion is a rare congenital abnormality. Preoperative diagnosis is difficult but can be based on scintigraphy using technetium 99m. In most cases, the splenic tissue can be dissected off the gonadal structures easily, and if there are any doubts concerning the nature of the swelling, an intraoperative frozen section can be performed to avoid an unnecessary orchidectomy. We report the case of a 4-year-old child in whom an inguinal mass indicated surgical exploration, which documented the histological diagnosis of splenogonadal fusion.

[Splenogonadal fusion. Report of a case]

We present a new case of splenogonadal fusion in a 27 years old male. This anomaly is the result of an embryological fusion between gonad and spleen. Occasionally there is an association with other congenital alterations (peromelia). Usually it occurs in the left scrotum and, although described in both sexes, it is more frequent in males. Its only symptom is palpable tumor and this makes the surgical approach the only way to make the diagnosis. A frozen section study can avoid unnecessary radical surgery.