Perineal ectopic testis: a rare cause of empty scrotum

Abstract

A male infant aged 5 months was referred to the endocrinology clinic at Tuzla Children ’ s Hospital by a primary healthcare physician who suspected left-side testicular retention after a routine examination. The infant was born on the 38th week of gestation to a primiparous mother, who had a normal pregnancy. On examination, the left hemiscrotum was noted to be poorly developed (Figure 1 , red arrow). Palpation of the left hemiscrotum and the left inguinal area did not reveal a testis. The right hemiscrotum was normally developed, and palpation revealed a testis of normal size. Examination of the surrounding area for the possible location for an ectopic testis (ET) revealed a perineal tumorous mass (Figure 1 , blue arrow), which, on palpation, was found to be fi xed and whose confi guration was identical to the right-side testis. No other abnormalities were noticed. ET is diagnosed in about 5 % of cases of empty scrotum. The most common site of ET is the superfi cial inguinal area, whereas other locations (femoral, perineal, prepenile, pubic area, contralateral hemiscrotum) are rarer. ET often remains undiagnosed for a long time or is wrongly diagnosed as cryptorchidism or even anorchia. ET should always be considered when the testis cannot be palpated in the scrotum or in the inguinal canal. It is always fi xed in an ectopic location, that is, it cannot move spontaneously, while movement on palpation is limited. With ET, there is a greater risk for trauma, torsion, or malignancy in adulthood in comparison with testes located in the scrotum. ET is an absolute indication for surgery, which should be undertaken in the fi rst 2 years of life.