|Year : 2016 | Volume
| Issue : 1 | Page : 71-73
Intra-abdominal supernumerary testis - Case report with a review of the literature
Sriharsha Bokka1, Suraj Jajoo2, Parag Gupta2, Sumanta Mishra2
1 Department of Surgery, ESIC Model Hospital, Hyderabad, Telangana, India
2 Department of General surgery, Jawaharlal Nehru Hospital and Research Centre, Bhilai, Chhattisgarh, India
|Date of Web Publication||17-Dec-2015|
Department of Surgery, ESIC Model Hospital, Hyderabad, Telangana
A 22-year-old male presented with signs and symptoms of acute appendicitis and was taken up for emergency appendicectomy. On exploration, an inflamed appendix was found and appendicectomy was done. After this, a cord-like structure was seen arising from the posterior peritoneum approximately 5 cm proximal to the appendicular stump that was traced to its origin and excised. This cord-like structure was sent for histopathological examination (HPE), which was suggestive of testicular tissue. The case was diagnosed as a supernumerary testis after confirming the presence of normal scrotal testes.
Keywords: Intra-abdominal, polyorchidism, supernumerary testis
|How to cite this article:|
Bokka S, Jajoo S, Gupta P, Mishra S. Intra-abdominal supernumerary testis - Case report with a review of the literature. Trop J Med Res 2016;19:71-3
|How to cite this URL:|
Bokka S, Jajoo S, Gupta P, Mishra S. Intra-abdominal supernumerary testis - Case report with a review of the literature. Trop J Med Res [serial online] 2016 [cited 2019 Jul 18];19:71-3. Available from: http://www.tjmrjournal.org/text.asp?2016/19/1/71/172066
| Introduction|| |
Supernumerary testis is a rare congenital anomaly with triorchidism being the most common form of polyorchidism reported in the literature. This congenital anomaly typically causes no impairment but is frequently associated with maldescended testis, inguinal hernia, and testicular torsion. The supernumerary testis is often located on the left side of the scrotum. Other locations include the inguinal and the retroperitoneal regions. But our report of a cord-like supernumerary testis, intra-abdominal in location, in a pediatric age group is probably the rarest of all types and has not been documented in the literature so far.
| Case Report|| |
A 22-year-old male presented with acute pain in the right iliac fossa. The signs and symptoms were in favor of acute appendicitis and hence, he was worked up for emergency appendicectomy. On exploration, an inflamed appendix, retrocecal in position, was found that was resected. The stump was not buried and just before the closure of the abdominal wound, a cord-like structure was seen arising from the posterior peritoneum approximately 5 cm proximal to the appendicular stump that was traced to its origin. As it was free from the viscera with no adhesions, the structure was excised and its base was inspected for any vascular connection and none was found [Figure 1]. The structure was sent for histopathological examination (HPE), which was suggestive of testicular tissue [Figure 2]. The case was diagnosed as a supernumerary testis after confirming the presence of normal scrotal testes. The patient is under regular follow-up and is doing well.
|Figure 1: Intra- and postoperative pictures of specimen, along with inflamed appendix|
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| Discussion|| |
Polyorchidism is a rare congenital anomaly of the genital tract in which more than two testes are present, usually within the scrotum. Triorchidism or tritestes, which refers to the presence of three testes, is the most frequent presentation and the supernumerary testis is often located on the left side of the scrotum.
The exact mechanism for the occurrence of polyorchidism is still not known. Several theories have been proposed, including peritoneal folding and segmentation of the primitive gonads, and longitudinal or transverse division of the genital ridge.
In fetal life, at about 6 weeks of gestation, the primordial testis develops from the primitive genital ridge medial to the mesonephric ducts. The primordial testis takes shape and the epididymis, along with the vas deferens arises from the mesonephric duct at 8 weeks. On the basis of embryologic development, Leung classified polyorchidism into four types. In type A, the division separates a small part of the genital ridge that does not come into contact with the mesonephric duct. Therefore, the supernumerary testis lacks the epididymis and the vas deferens. In type B, the division of the genital ridge occurs in the region where the primordial gonads are attached to the mesonephric ducts and the supernumerary testis has its own epididymis. In type C, the supernumerary testis has its own epididymis and shares the vas deferens with the regular testis in a parallel fashion. In this type of polyorchidism, there is an incomplete longitudinal division of the genital ridge and the proximal portion of the mesonephric duct. In type D, which is the least common, complete longitudinal duplication of the genital ridge and the mesonephric duct occurs with resultant complete duplication of the testes, the epididymides, and the vas deferens.
Most patients with polyorchidism have a normal 46, XY karyotype. However, chromosomal abnormalities such as 46, XX karyotype with XY mosaicism and deletion of the long arm of chromosome 21 have been reported. In polyorchidism, secondary sexual characteristics are the same as in typical individuals of a similar age.
Anomalies associated with polyorchidism generally include inguinal hernia in cryptorchidism, testicular torsion, and microlithiasis.
Polyorchidism in general is an incidental finding associated with hydrocele, epididymitis, varicocele, infertility, retractile testes, and hypospadias. Reports in the literature have also described an increased risk of testicular malignancy (6.4%) in the presence of polyorchidism. Malignant transformation may occur regardless of the location of the supernumerary testicle. The most commonly reported neoplasms are embryonal carcinomas, germ cell tumors, and seminomas. Extratesticular rhabdomyosarcoma and adenoma of the rete testis in the supernumerary testicle have also been noted.
Polyorchidism is usually diagnosed on the basis of color Doppler ultrasound, further supported by magnetic resonance imaging (MRI). The supernumerary testicle generally demonstrates echotexture and vascular flow similar to those of the normal testicles. MRI can be helpful if an ultrasound-based diagnosis is not definitive. The supernumerary testicle has the same MRI features as a normal testicle: intermediate signal intensity on T1-weighted images and high signal intensity on T2-weighted images. The differential diagnosis of polyorchidism includes an extratesticular or paratesticular mass, such as hydroceles, varicoceles, lipomas, tumors, and/or hernia.
The management of polyorchidism should usually be a resection of the dysplastic testicle without a duct; otherwise, the supernumerary testis should be retained and followed-up by yearly ultrasound because of its contribution to spermatogenesis. However, any suspected malignancy of the supernumerary testicle should be managed by orchiectomy. If malignancy is not suspected, the patient can be followed-up conservatively.
Supernumerary testis, which is scrotal in location, is a rather commoner entity clinically identified or with imaging modality. But our experience is totally new and we happened to encounter it accidentally. Hence, we cannot provide any sort of conclusion based on a single observation. But the excision of such tissue is a suggestion in view of the complications pertaining to an undescended or an ectopic testis. The purpose of our report is not only to document the rarest variety of supernumerary testis but also to expand the spectrum of the particular condition in terms of its presentation, the diagnostic dilemma posed by it, and its management.
| References|| |
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[Figure 1], [Figure 2]