Abdominal polyorchidism: an unusual variant

Triorchidism; an incidental finding at inguinal hernia repair: A case report

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.

Polyorchidism and adenomatous hyperplasia of the rete testis: a case report with sonographic and magnetic resonance imaging findings and review of literature

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.

Polyorchidism: a three-case report and review of the literature

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.

Supernumerary testis: a case report and review of literature

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.

Polyorchidism

The authors present a case study of polyorchidism in a young adolescent. Polyorchidism is a rare occurrence but may be discovered with greater frequency due to the widespread use of sonography. Sonographers should be aware of the clinical symptoms, sonographic presentations, and advantages of sonography over other modalities or more invasive means of diagnosis. Polyorchidism is the rare presence of one or more additional testes. The supernumerary (additional) testis may appear in a variety of ways to include its development and location. According to some theories, the development of the super-numerary testis is dependent on which division occurs during the embryonic stage. The discovery of polyorchidism is usually an incidental finding during inguinal hernia repairs and other imaging modalities, but with the use of color Doppler, power Doppler, and various imaging planes, sonography is the modality of choice to assist in the diagnosis.

Unusual mixed gonadal dysgenesis associated with Müllerian duct persistence, polygonadia, and a 45,X/46,X,idic(Y)(p) karyotype

Mixed gonadal dysgenesis (MGD) is a developmental anomaly in which most of the patients have a dysgenetic testis, a contralateral streak and a 45,X/46,XY karyotype. This entity involves an heterogeneous group of gonadal and phenotypic abnormalities with a wide clinical spectrum. The phenotype depends on the ratio of testicular tissue which induces virilization. Although the karyotype in these patients is 45,X/46,XY, no genotype-phenotype correlation has been found to date. Müllerian ducts persistence (MDP) in MGD is rare; however, four patients with both entities and different karyotypes have been described. Here we present the data on a newborn patient with an atypical MGD associated with MDP, two left testes, a gonadal streak on the right, and absence of Wolffian derivatives. PCR analysis identified all the Y-derived sequence tested in the father, while the patient had them all except the AZF b,c regions which were lost. FISH analysis of the paternal Y chromosome documented Yq paracentric inversion while the patient's karyotype was 45,X/46,X,idic(Yp). No mutations were observed in MIS/MISRII genes.

Abdominal polyorchidism: A case report and review of the literature

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%).

Polyorchidism: report of 3 cases and review of the literature

OBJECTIVE

To describe the embryologic, clinical, sonographic, and magnetic resonance imaging features of polyorchidism and to review the literature on similar cases.

METHODS

Over a 5-year period, we encountered 3 patients who were found to have polyorchidism on scrotal sonography. All 3 patients had a painless scrotal mass. Two patients also had magnetic resonance imaging of the scrotum, and the results were correlated with the sonograms. We also performed a literature search for other reports of polyorchidism.

RESULTS

One patient had 2 right testicles and a single left testicle. The second patient had 3 left testicles and 1 right testicle. In the third patient, who had 2 left testicles and 1 right testicle, microlithiasis was found in all 3 testes. The supernumerary testes were within the scrotum in all cases. All testicles were identified by sonography. Magnetic resonance imaging in 2 cases provided confirmatory data regarding the presence of an extra testicle but did not add other relevant information. Conservative treatment was chosen in all cases.

CONCLUSIONS

Polyorchidism is a rare congenital anomaly. There are characteristic sonographic features of polyorchidism, and the diagnosis is often made on the basis of sonography. Magnetic resonance imaging can be used for confirmation but may be more helpful in cases complicated by cryptorchism or neoplasia. Conservative treatment is advised in uncomplicated cases.

Sonographic Diagnosis of Polyorchidism

Polyorchidism, or duplication of testes, is a unique and rare anomaly. Sonography is ideally suited for the diagnosis of polyorchidism and associated pathologies and anomalies. High frequency transducers exceeding 10 MHz, with the inherent increase in spatial and contrast resolution, may play a decisive role in clinical management of polyorchidism. In this case report, the authors describe the benefit of high frequency transducers.

Polyorchidism: functional classification and management strategy

Polyorchidism is rare. We report a recent case and review the literature. A simple classification based on anatomic and functional arrangements of the testes and their drainage systems is described. Combining this classification with a knowledge of potential complications, we propose a management strategy.

Chromosomal anomaly and malformation syndrome with abdominal polyorchidism

We describe a neonate who presented with multiple severe malformations including polyorchidism. To our knowledge this is the second case reported with ipsilateral testes located intra-abdominally. Chromosomal studies in cases of polyorchidism have been reported previously only once and the patient exhibited a normal karyotype. Our patient had a chromosome 21 long arm deletion. Interestingly, a trisomy 21 patient has been reported with agonadism. We suggest that genes on chromosome 21 may have some role in gonadal development.

Polyorchidism: case report and review of literature

Polyorchidism is a rare anomaly with approximately 70 cases reported in the literature. It may result from transverse division of the urogenital ridge, a hypothesis that best explains the anatomical features of the supernumerary testicle. The primary accompanying disorders and anomalies include maldescended testis, inguinal hernia and torsion. Malignancy has been reported in 3 cases. In the absence of any concomitant disorder and if testicular tumor can be ruled out by magnetic resonance imaging and ultrasonography, surgical exploration with biopsy is unnecessary.

Polyorchidism in a newborn: case report and review of the literature

A case of polyorchidism in a newborn is reported. The left scrotum contained two testes sharing the same epididymis and vas deferens. The histometric testicular parameters were normal in the three testes, except for a slightly reduced tubular fertility index in the supernumerary testis.