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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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2
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Gune AR, Gune RP. Triorchidism: a rare case report. AFRICAN JOURNAL OF UROLOGY 2021. [DOI: 10.1186/s12301-020-00113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The presence of an extra testis is referred to as polyorchidism and is a rare congenital anomaly. There are with less than 200 cases reported, globally. It carries with it, a risk of malignancy making astute diagnosis and follow-up important. The management protocol of polyorchidism is ambiguous with factors such as age of the patient, location, size and anatomical organization of the testicular system playing an important role.
Case presentation
A 28-year-old male who presented with a non- tender scrotal swelling which on clinical and sonographic examination was diagnosed to be a case of triorchidism (the most common type of polyorchidism). Type 2 polyorchidism with normal epididymis and vas deference was observed. The case was conservatively managed and regular follow-up was advised.
Conclusion
Polyorchidism is a rare congenital anomaly. Patients with Polyorchidism can be conservatively managed. The reproductive potential and possible concomitant symptoms and complications including cryptorchidism, inguinal hernia and torsion will affect the management strategy. However, if the supernumerary testis is suspected of undergoing neoplastic transformation, it should be resected.
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3
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Cohen T, Agard H, Parekh N, Clark C. Management of Bilateral Undescended Bilobed Testes and Review of the Literature. Urology 2017; 110:213-215. [PMID: 28860052 DOI: 10.1016/j.urology.2017.08.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/13/2017] [Accepted: 08/17/2017] [Indexed: 11/15/2022]
Abstract
Polyorchidism is a rare anomaly of testicular development. Particularly, a bilobed testis is an extremely rare congenital malformation, which is thought to be a variant expression of polyorchidism. Only 5 cases of bilobed testis have been reported in the literature to date. This report is of bilateral, undescended, bilobed testes in a 15-month-old boy who has multiple other malformations of possible genetic etiology.
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Affiliation(s)
- Tal Cohen
- Northeast Ohio Medical University, Akron, OH.
| | | | | | - Curtis Clark
- Pediatric & Adolescent Urology, Inc. and Division of Pediatric Urology, Akron Children's Hospital, Akron, OH
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4
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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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5
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Nistal M, Paniagua R, González-Peramato P, Reyes-Múgica M. Perspectives in Pediatric Pathology, Chapter 9. Alterations in the Number and Location of the Testis. Pediatr Dev Pathol 2015; 18:433-45. [PMID: 25105857 DOI: 10.2350/14-04-1468-pb.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Manuel Nistal
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Ricardo Paniagua
- 2 Department of Cell Biology, Universidad de Alcala, Madrid, Spain
| | - Pilar González-Peramato
- 1 Department of Pathology, Hospital La Paz, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo No. 2, Madrid 28029, Spain
| | - Miguel Reyes-Múgica
- 3 Department of Pathology, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, One Children's Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA
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6
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Leodoro BM, Beasley SW, Stringer MD. Polyorchidism with presumed contralateral intrauterine testicular torsion. Int J Surg Case Rep 2014; 5:865-7. [PMID: 25462053 PMCID: PMC4245670 DOI: 10.1016/j.ijscr.2014.09.035] [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] [Received: 02/16/2014] [Revised: 09/15/2014] [Accepted: 09/15/2014] [Indexed: 11/26/2022] Open
Abstract
The sentence, “Since then fewer than 200 cases have been reported in children and adults2” has been updated to “Since then nearly 230 cases of polyorchidism have been reported with a meta-analysis revealing 140 cases of histologically confirmed polyorchidism in children and adults.2” The sentence “It occurs mostly on the left side, with only a few reports of right sided polyorchidism3,4” has been changed to “Right sided polyorchidism is less common than on the left side.” Prenatal testicular torsion reportedly occurs in approximately 6.1 per 100,000 births.7,8 The frequency may be higher given that the infarcted testis gets resorbed giving rise to reports of the “vanishing testis” as is most likely in this case.8 While prenatal testicular torsion is increasingly being recognized and treated as a surgical emergency,9 prenatal testicular torsion in association with polyorchidism has not been previously reported.” has been included.
INTRODUCTION Polyorchidism was first described by Blasius in 16701 during a routine autopsy. We report a child with unilateral polyorchidism and a contralateral absent testis, a combination not reported previously. PRESENTATION OF CASE A 2-year-old boy was referred to the outpatient clinic with an impalpable left testis. At laparoscopy, the left vas deferens and testicular vessels ended blindly proximal to a closed internal ring. No gonadal tissue was identified. On the right side, a single vas deferens and testicular vessels were seen entering the internal ring as normal. The right side of the scrotum was explored and two testes were identified within a single tunica vaginalis. DISCUSSION Polyorchidism is rare with a literature search identifying approximately 230 reported cases. Whilst prenatal testicular torsion is increasing being recognized and treated as a surgical emergency,9 prenatal testicular torsion in association with polyorchidism has not been previously reported. CONCLUSION We describe a unique case of a 2-year-old boy with right-sided polyorchidism and an absent left testis associated with a blind ending vas deferens and testicular vessels, presumed secondary to intrauterine testicular torsion.
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Affiliation(s)
- B M Leodoro
- Department of Surgery, Vila Central Hospital, Port Vila, Vanuatu.
| | - S W Beasley
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
| | - M D Stringer
- Department of Paediatric Surgery, Christchurch Hospital, Christchurch, New Zealand
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Abstract
Supernumerary testis is a rare congenital anomaly of the testis arising from abnormal division in the genital ridge during the embryogenesis of testis. We describe a case of polyorchidism detected incidentally in a 52-year-old with renal failure.
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Affiliation(s)
- Sandeep G Jakhere
- Department of Radiology, B. Y. L. Nair Charitable Hospital and T. N. Medical College, Mumbai, Maharashtra, India
| | - Shenaz A Saifi
- Department of Radiology, B. Y. L. Nair Charitable Hospital and T. N. Medical College, Mumbai, Maharashtra, India
| | - Abhinav A Ranwaka
- Department of Radiology, B. Y. L. Nair Charitable Hospital and T. N. Medical College, Mumbai, Maharashtra, India
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8
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Polyorchidism presenting with inguinal hernia and hypospadias. Case Rep Urol 2013; 2013:917050. [PMID: 23997977 PMCID: PMC3749609 DOI: 10.1155/2013/917050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 07/18/2013] [Indexed: 11/26/2022] Open
Abstract
Polyorchidism is defined as the presence of more than two testes. Triorchidism is the most frequent presentation. This anomaly is extremely rare, and approximately a hundred cases were described in the literature. We report a case of triorchidism presenting with inguinal hernia and penoscrotal hypospadias in a three-year-old male and briefly discuss current management of polyorchidism. Management remains controversial especially if there is no associated abnormality identified. The absence of any concomitant disorder and if testicular tumour can be ruled out by sonography or magnetic resonance imaging, surgical exploration with biopsy could be unnecessary. On the contrary, surgical exploration has the advantage of allowing for fixation of the testes to prevent torsion and determination of testicular outflow tracts and estimating reproductive capacity.
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9
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Ogul H, Pirimoglu B, Taskın GA, Bayraktutan U, Ozgokce M, Kantarci M. Polyorchidism and adenomatous hyperplasia of the rete testis: a case report with sonographic and magnetic resonance imaging findings and review of literature. Andrologia 2013; 46:449-52. [PMID: 23521395 DOI: 10.1111/and.12090] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2013] [Indexed: 11/28/2022] Open
Abstract
Supernumerary testis or polyorchidism is a rare congenital anomaly with about 200 reported cases in the literature. It may be associated with cryptorchidism, testicular torsion and neoplasms. Ultrasonography and magnetic resonance imaging are effective noninvasive methods of accurately detecting polyorchidism. In most cases, ultrasonography is diagnostic and magnetic resonance imaging plays confirmatory role by providing additional information if complicated with neoplasia. We report a case of 16-year-old man with right supernumerary testis associated with adenomatous hyperplasia of the rete testis, its sonographic and magnetic resonance imaging findings and management.
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Affiliation(s)
- H Ogul
- Department of Radiology, Medical Faculty, Ataturk University, Erzurum, Turkey
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10
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Thyoka M, Lall A, Godse A. Polyorchidism: a torted right-sided supernumerary testis. BMJ Case Rep 2013; 2013:bcr-2013-008600. [PMID: 23417389 DOI: 10.1136/bcr-2013-008600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Polyorchidism is a rare congenital anomaly defined by the presence of more than two histologically proven testes. The commonest variant is triorchidism, the supernumerary testis being commonly reported on the left side. Most cases of polyorchidism are found incidentally in association with undescended testis, hydrocele, hernia or torsion. We report a right-sided triorchidism in a 15-year-old boy found at time of groin exploration for an irreducible right inguinal hernia.
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Affiliation(s)
- Mandela Thyoka
- Department of Paediatric Surgery, UCL Institute of Child Health, London, UK.
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11
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Beiko D, Macneily AE. Torsion of bilobed testis and biopsy-proven ipsilateral supernumerary testis in an adolescent. Can Urol Assoc J 2013; 4:E67-70. [PMID: 23293690 DOI: 10.5489/cuaj.860] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Testicular torsion in patients with polyorchidism is rare, with less than 20 cases being reported. Bilobed testis has only been reported once in the literature to date. We report an interesting case of polyorchidism with torsion of an ipsilateral bilobed testis. The abnormal looking bilobed infarcted testis was removed, but the smaller viable supernumerary testis was biopsied and preserved.
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Affiliation(s)
- Darren Beiko
- Assistant Professor, Department of Urology, Queen's University, Kingston General Hospital, Kingston, ON
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12
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Abstract
Polyorchidism, the presence of more than two testes, is a very rare anomaly. We report the color Doppler ultrasonography and magnetic resonance imaging findings of the case of a 20-year-old man with polyorchidism, presenting with an asymptomatic scrotal mass. Ultrasonography showed double testes with double separate epididymides sharing a common vas deferens in the left side of the scrotum. The double testes demonstrated similar echo texture and vascular flow as the normal testis, but smaller in size. Magnetic resonance imaging showed three testes very clearly and confirmed the diagnoses. After 2 years of follow-up, he was managed with surgical intervention. Pathology report revealed polyorchidism.
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13
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Kajbafzadeh AM, Ghahestani SM, Zamani MM, Kajbafzadeh M, Kia MM. A Novel Approach in Eight Polyorchidism Cases: Vasoepidydimal or Epididymo-epididymal Approximation in Single Vas Deferens Duplicated Testis. Urology 2012; 79:1346-9. [DOI: 10.1016/j.urology.2012.02.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Revised: 01/12/2012] [Accepted: 02/10/2012] [Indexed: 10/28/2022]
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14
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Topsakal K, Ak H, Yumurtas N. Polyorchidism with varicocele: a case report and review of literature. Andrologia 2011; 44 Suppl 1:829-32. [DOI: 10.1111/j.1439-0272.2011.01205.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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15
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De Carli C, Guerra L, Leonard M. Bilobed testicle in children: diagnosis and management. Can Urol Assoc J 2011; 3:E87-8. [PMID: 20019962 DOI: 10.5489/cuaj.1188] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Bilobed testicle is an extremely rare testicular malformation in children. It may be presumed that this condition could be an incomplete expression of polyorchidism; however, the etiology of both entities remains unknown. In this report, a 3-year-old boy presented with a right bilobed testicle mimicking a testicular tumour. Since there are insufficient data in the pediatric literature presenting the ideal management of bilobed testicles, we believe it is important to report this case to provide more information about this condition. Although rare, bilobed testis should be considered in the differential diagnosis of a testicular mass. Surgical treatment is not mandatory, and conservative follow-up may play a role.
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16
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Repetto P, Ceccarelli P, Bianchini A, Durante V, Biondini D, Cacciari A. Three small testes in left hemiscrotum: a rarer case of polyorchidism. J Pediatr Surg 2010; 45:e21-3. [PMID: 20152334 DOI: 10.1016/j.jpedsurg.2009.12.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2009] [Revised: 12/10/2009] [Accepted: 12/10/2009] [Indexed: 11/25/2022]
Abstract
Polyorchidism is a rare congenital anomaly. A review of literature has yielded about 100 cases. We describe a rarer case of polyorchidism consisting of 3 testes on left hemiscrotum and one normal testis in right hemiscrotum. Diagnosis and management are discussed.
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Affiliation(s)
- Paolo Repetto
- Department of Pediatric Surgery, Modena Policlinic University Hospital, Modena, Italy.
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17
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Savas M, Yeni E, Ciftci H, Cece H, Topal U, Utangac MM. Polyorchidism: a three-case report and review of the literature. Andrologia 2010; 42:57-61. [PMID: 20078517 DOI: 10.1111/j.1439-0272.2009.00957.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The presence of more than two testes confirmed by histology is called polyorchidism. Polyorchidism is an extremely rare congenital anomaly with a few more than 100 cases reported in the literature. The majority of reported cases are asymptomatic patients, others present with cryptorchidism, hydrocele, varicocele, epididymitis, infertility, testicular malignancy and testicular torsion. Over a 2-year period, we encountered three patients who were found to have polyorchidism; two men presented with cryptorchidism and one with chronic scrotal pain. Physical examination of the first and the third patient revealed normal testes in the scrotal sac, the other scrotal sac was empty and small solid mass (atrophic left testes) was palpated in the inguinal canal. Ultrasonographic examination of the scrotum and inguinal region confirmed the findings of the physical examination. Ultrasonographic examination of the second patient revealed supernumerary testes within the scrotum. Orchiectomy was made on the first and third patients' supernumerary testes and ipsilateral inguinal high ligation was applied for herniorrhaphy. A conservative approach was preferred for the second patient, maybe preserving a potentially functional supernumerary testis to improve the capacity for spermatogenesis. The risk of malignancy justifies the removal of an atrophic and ectopic testis in polyorchidism. However, it would appear safe to preserve a viable intrascrotal supernumerary testis found incidentally at surgery, provided that the patient is followed-up in the long term.
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Affiliation(s)
- M Savas
- Department of Urology, Harran University, Sanliurfa, Turkey.
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18
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Chintamani J, Nyapathy2 V, Chauhan3 A, Krishnamurthy4 U. Supernumerary testis. J Radiol Case Rep 2009; 3:29-32. [PMID: 22470628 DOI: 10.3941/jrcr.v3i11.308] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Polyorchidism is a rare congenital anomaly of the genital tract in which more than two testes are present, usually within the scrotum. Less than 100 cases of polyorchidism have been reported in medical literature till date. The most common form is the presence of three testis referred as triorchidism or tritestis. There are characteristic sonographic features of polyorchidism, and the diagnosis is often made on the basis of ultrasonography. Magnetic resonance imaging can be used for confirmation. We present a case of polyorchidism in a 13 yrs old adolescent.
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Affiliation(s)
- Jaiger Chintamani
- Department of Radiodiagnosis, R.L. Jalappa hospital, Tamaka, Kolar, Karnataka, India
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19
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Hunald F, Rakototiana A, Razafimanjato N, Tsiaviry P, Ahmad A, Rantomalala H. Un cas rare de polyorchidie : revue de la littérature. Arch Pediatr 2008; 15:1430-2. [DOI: 10.1016/j.arcped.2008.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 04/17/2008] [Accepted: 06/01/2008] [Indexed: 10/21/2022]
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20
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Francesco A, Antonio NP, Salvatore A, Daniela V, Biagio Z, Giuseppe R. Immunohistochemistry: Additional armamentarium in the management of polyorchidism. Pediatr Int 2008; 50:586-8. [PMID: 18937760 DOI: 10.1111/j.1442-200x.2008.02675.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Arena Francesco
- Department of Medical and Surgical Pediatric Sciences, Unit of Pediatric Surgery, University of Messina, Messina, Italy.
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21
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Kumar B, Sharma C, Sinha DD. Supernumerary testis: a case report and review of literature. J Pediatr Surg 2008; 43:E9-E10. [PMID: 18558166 DOI: 10.1016/j.jpedsurg.2008.01.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 01/18/2008] [Accepted: 01/22/2008] [Indexed: 10/21/2022]
Abstract
Supernumerary testis or polyorchidism is a rare anatomical and congenital anomaly, and approximately 100 cases have been reported in the literature so far. It is often associated with processus vaginalis anomalies and with increased risk of malignancy and infertility. We report a case and its management, having left-sided duplex testis and found incidentally during inguinal hernia repair, and review the literature.
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Affiliation(s)
- Basant Kumar
- Department of Pediatric Surgery, Sir Padampat Mother and Child Health Institute, JayKayLon Hospital, SMS Medical College, Jaipur, Rajasthan, India.
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22
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Khedis M, Nohra J, Dierickx L, Walschaerts M, Soulié M, Thonneau PF, Plante P, Huyghe E. Polyorchidism: Presentation of 2 Cases, Review of the Literature and a New Management Strategy. Urol Int 2008; 80:98-101. [DOI: 10.1159/000111738] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2006] [Accepted: 01/08/2007] [Indexed: 11/19/2022]
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24
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Abstract
Polyorchidism is an uncommon congenital anomaly, defined as the presence of more than 2-histologically proven-testes. Approximately 90 cases are reported in the literature. It is found predominantly on the left side. We report a right-sided polyorchidism found during orchidopexy in a 6-year-old boy. The supernumerary testis had its own tunica vaginalis, epididymis, and deferent duct, but shared the blood supply with the ipsilateral distal testis. The diagnosis was confirmed histologically. Because of the shortness of its vessels, the supernumerary testis could not undergo orchidopexy and was removed. We review the classification systems proposed for polyorchidism. Most are based on embryologic considerations, but none is capable of including all cases described in the literature. Thus, we present an anatomical system for a more comprehensive taxonomy of polyorchidism according to its reproductive function.
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Affiliation(s)
- Robert Bergholz
- Department of Pediatric Surgery, Medical School, Westfalian Wilhelms University of Muenster, 48149 Muenster, Germany.
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25
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Bhogal RH, Palit A, Prasad KK. Conservative management of polyorchidism in a young man: a case report and review of literature. Pediatr Surg Int 2007; 23:689-91. [PMID: 17102997 DOI: 10.1007/s00383-006-1835-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2006] [Accepted: 10/19/2006] [Indexed: 10/23/2022]
Abstract
Approximately 100 cases of polyorchidism have been reported in the literature. Management remains controversial especially if there is no associated abnormality identified. We report a case of triorchidism confirmed by magnetic resonance imaging (MRI). The patient has been managed conservatively and remains under regular radiological follow-up with MRI.
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Affiliation(s)
- Ricky H Bhogal
- Department of Urology, George Eliot Hospital, Nuneaton, UK.
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26
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Nane I, Ozkan L, Ander H. Inguinal orchiectomy for the extra testis with suspected tumor in a polyorchidic patient: a case report. Int Urol Nephrol 2006; 39:557-9. [PMID: 17171418 DOI: 10.1007/s11255-006-9038-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2006] [Accepted: 05/08/2006] [Indexed: 11/30/2022]
Abstract
A 29-years-old male patient presented with complaint of the small size of his left testicle. The physical examination revealed a normal right testicle with 15 cc volume, a small left testicle (5 cc) and a 4 cc mass under the left testicle, which was thought to be a spermatocele. Ultrasonographic imaging was performed and the mass was defined as a third testicle with a heterogenic epididymis. Scrotal magnetic resonance imaging (MRI) confirmed the diagnosis. An inguinal exploration was performed, which resulted in a left orchiectomy and biopsy of the superior left testicle. The pathologic examination revealed hyperplasia with microcystic changes in the orchiectomy specimen and severe hypospermatogenesis in the biopsy sample. There were no significant changes in semen analysis after the operation.
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Affiliation(s)
- Ismet Nane
- Istanbul Faculty of Medicine, Urology Department, Istanbul University, Capa, Istanbul, Turkey.
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Velásquez López JG, Flórez Silva FR, López Montoya LJ. [Polyorchidism: a case report and review of the literature]. Actas Urol Esp 2006; 30:415-9. [PMID: 16838616 DOI: 10.1016/s0210-4806(06)73468-4] [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: 11/21/2022]
Abstract
Polyorchidism is an uncommon congenital defect. In fact, less than one hundred cases have been reported in the medical literature worldwide. This problem should be considered in the differential diagnosis of all scrotal masses. It is associated with multiple other urologic entities including malignancy. It is for this reason that it is important to be familiar with potential diagnostic and therapeutic strategies. This diagnosis is usually documented by imaging, specifically doppler ultrasound (US) and magnetic resonance imaging (MRI). The risk of malignancy approaches 6% in Polyorchidism and therefore several authors have advocated surgery as the most appropriate therapeutic approach. However, recent reports suggest that asymptomatic patients with normal imaging could be observed. We present a 14 year old boy with polyorchidism which was diagnosed clinically and confirmed with imaging. His treatment and a review of the literature are presented as well.
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Zuppa AA, Nanni L, Di Gregorio F, Visintini F, Buonuomo V, Pintus C. Complete epididymal separation presenting as polyorchidism. JOURNAL OF CLINICAL ULTRASOUND : JCU 2006; 34:258-60. [PMID: 16673372 DOI: 10.1002/jcu.20190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We describe an unusual case of a 21-month-old boy with complete separation of the testis and epididymis. Two homogeneous structures were observed in the scrotum of a newborn boy in addition to a third structure. Polyorchidism was suspected, but follow-up sonographic studies showed a decrease in the echogenicity of the left scrotal structure. Surgical exploration revealed the testis and epididymis to be completely separated, with no duplicated testis. Orchidopexy was then performed.
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Affiliation(s)
- Antonio Alberto Zuppa
- Division of Neonatology, Department of Pediatrics, Università Cattolica del S. Cuore, Policlinico A. Gemelli, Rome, Italy
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Oner AY, Sahin C, Pocan S, Kizilkaya E. Polyorchidism: sonographic and magnetic resonance image findings. Acta Radiol 2005; 46:769-71. [PMID: 16372700 DOI: 10.1080/02841850500216293] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Polyorchidism is a rare congenital anomaly frequently associated with maldescent testis, hernia, and torsion. Reports in the literature show an increased risk of testicular malignancy in the presence of polyorchidism. This entity has characteristic sonographic features and the diagnosis is often made on the basis of sonography. Magnetic resonance imaging might also be used for the diagnosis, but is more helpful in cases associated with cryptorchism or neoplasia. A conservative approach is the treatment of choice in uncomplicated cases.
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Affiliation(s)
- A Y Oner
- Department of Radiology, Gazi University School of Medicine, Ankara, Turkey.
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30
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Abstract
Two cases of polyorchidism with 2 left scrotal testes are referred. In both patients, the segmented gonads showed a "bell clapper" deformity. In the first patient, the contralateral gonad also presented a large mesorchium and absence of scrotal ligament, whereas in the second case, the right gonad was firmly adhered to the tunica vaginalis because of a previous appendix testis torsion. Orchidopexy of all testes, judged at risk for torsion, was performed. Contrary to what is recommended by recent literature, we consider scrotal exploration and testis fixation mandatory of the contralateral, apparently normal gonad as well, even in the absence of clinical and ultrasound signs of associated abnormalities or complications.
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Affiliation(s)
- Fabio Ferro
- Andrological Surgery Unit, Bambino Gesù Children's Hospital, 00165 Rome, Italy.
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31
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Yeniyol CO, Nergiz N, Tuna A. Abdominal polyorchidism: A case report and review of the literature. Int Urol Nephrol 2004; 36:407-8. [PMID: 15783116 DOI: 10.1007/s11255-004-8870-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Abdominal polyorchidism is rare. We report a case and review the literature. We suggest a very watchful abdominal evaluation of patients for a second ipsilateral testis who are operated for undescent testis. Polyorchidism is a very rare anomaly which requires definitive histological diagnosis. Although imaging techniques may be helpful in the diagnosis, it's mostly incidentally found in surgical exploration. Patients may present with pain or scrotal swelling. Most commonly abnormalities are maldescent (40%), hernia (30%), torsion (15%), hydrocele (9%) and malignancy (6%).
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Deveci S, Aygün C, Agildere AM, Ozkardes H. Bilateral double testis: Evaluation by magnetic resonance imaging. Int J Urol 2004; 11:813-5. [PMID: 15379955 DOI: 10.1111/j.1442-2042.2004.00878.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Bilateral double testis, a varient of polyorchidism, is a rare malformation of which six cases have been reported in the published literature. Magnetic resonance imaging was used in the presented case to confirm the diagnosis without surgical exploration.
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Affiliation(s)
- Serkan Deveci
- Department of Urology, Baskent University School of Medicine, Bahçelievler 06490, Ankara, Turkey
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Pomara G, Cuttano MG, Romano G, Bertozzi MA, Catuogno C, Selli C. Surgical management of polyorchidism in a patient with fertility problems. JOURNAL OF ANDROLOGY 2003; 24:497-8. [PMID: 12826688 DOI: 10.1002/j.1939-4640.2003.tb02700.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Giorgio Pomara
- Departments of Urology and Andrology, S. Chiara Hospital, Pisa University, Italy.
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Woodward PJ, Schwab CM, Sesterhenn IA. From the archives of the AFIP: extratesticular scrotal masses: radiologic-pathologic correlation. Radiographics 2003; 23:215-40. [PMID: 12533657 DOI: 10.1148/rg.231025133] [Citation(s) in RCA: 204] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The extratesticular scrotal contents consist of the epididymis, spermatic cord, and fascia derived from the embryologic descent of the testis through the abdominal wall. As opposed to intratesticular masses, most extratesticular masses are benign. Cystic masses (including hydroceles, epididymal cysts, and varicoceles) are easily diagnosed with ultrasonography (US) and are benign. Epididymitis is a common extratesticular lesion as well as the most frequent cause of an acute scrotum. It may be either acute or chronic and can be potentially complicated by epididymo-orchitis or scrotal abscess. Findings include epididymal enlargement, skin thickening, hydroceles, and hyperemia. The epididymis can also be affected by sarcoidosis, a noninfectious granulomatous disorder. The most common extratesticular neoplasms are lipomas (most often arising from the spermatic cord) and adenomatoid tumors (most often found in the epididymis). Despite their relative rarity, malignant neoplasms do occur and include rhabdomyosarcoma, liposarcoma, leiomyosarcoma, malignant fibrous histiocytoma, mesothelioma, and lymphoma. These tumors are often large at the time of presentation. The US findings of solid masses are often nonspecific. Magnetic resonance imaging can be very helpful in the evaluation of some of these disorders, allowing for a more specific diagnosis in cases of lipoma, fibrous pseudotumor, and polyorchidism.
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Affiliation(s)
- Paula J Woodward
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, 14th and Alaska NW, Bldg 54, Rm M-121, Washington, DC 20306-6000, USA.
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Abstract
Polyorchidism is an uncommon congenital anomaly of the genital tract defined as the presence of more than two testes. Polyorchidism is associated with maldescent testis, inguinal hernia, torsion, and an increased risk of malignancy. However, if a neoplasm is ruled out by ultrasonography, surgical exploration is not needed. We report a case of multiple testicular glands.
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Affiliation(s)
- Andreas P Berger
- Department of Urology, University of Innsbruck, Innsbruck, Austria
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36
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Makowska-Webb J, Asamoah DK. Case of the month: a scrotal lump. Br J Radiol 2002; 75:635-6. [PMID: 12145140 DOI: 10.1259/bjr.75.895.750635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- J Makowska-Webb
- Department of Radiology, Warrington Hospital NHS Trust, Lovely Lane, Warrington WA5 1QG, UK
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Figler TJ, Olson MC, Kinzler GJ. Polyorchidism and rete testis adenoma: ultrasound and MR findings. ABDOMINAL IMAGING 1996; 21:470-2. [PMID: 8832875 DOI: 10.1007/s002619900108] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Polyorchidism is an uncommon congenital anomaly. It is associated with an increased frequency of testicular malignancy, cryptorchidism, inguinal hernia, and torsion. Sonography may be used to confirm the clinically suspected diagnosis. We present a case of polyorchidism in which a rete testis adenoma was present in one of the testicles. Sonographic and magnetic resonance findings are illustrated.
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Affiliation(s)
- T J Figler
- Department of Diagnostic Radiology, Loyola University Medical Center, 2160 South First Avenue, Maywood, IL 60153, USA
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