Triorchidism: a rare genital abnormality

Abstract

1However, the most of patients are asymptomatic and usually diagnosed incidentally. Some may present as inguinal hernia (30%), maldescended testis (15% to 30%), testicular torsion (13%) and hydrocele (9%), varicocele (1%), hypospadias (<1%), anomalous urogenital union (<1%), and malignancy (<1%). 2 Management of polyorchidism is still controversial. Important factors of polyorchidism management are testis location, size and anatomical organization of the testicular drainage system and the age of the patient. A 28-year-old single Turkish man presented to our clinic with 12 years history of a small palpable lump in the left hemi-scrotum. There were no other urological and general medical symptoms or significant past medical history. Physical examination was normal with no palpable mass on abdomen wall and no palpable inguinal herniae. Scrotal examination revealed a normal right testis and scrotal content, but on the left-side there were palpated two mass in similar size. It was difficult to make a distinction between the normal testis and the mass because of their similar consistency and size. They were separate testis and had two epididymis and two vas deferens. In laboratory findings such as human chorionic gonadotropin and α-fetoprotein and lactate dehidrogenase were in normal range. Scrotal ultrasound identified a left-side duplicated testis with normal echo-texture and blood flow. Scrotal magnetic resonance imaging (MRI) scan was performed for confirming the diagnosis and anatomical evaluations. MRI showed single right testicle and a left-side double testis having their own epididymis and vas deferences (Figure 1). Blasius recorded the first case of triorchidism at a routine autopsy in 1670. 1 The first histologically documented case of polyorchidism was reported by Lane in 1895. Most patients with polyorchidism has been identified especially early adulthood period and the majority of supernumerary testes are located in the scrotal region (66%) followed by inguinal (23%) and abdominal (9%) positions. The most common type of polyorchidism is triorchidism with the supernumerary testis detected to the left-side as our case. 3