Undescended Testis: The Risk Always Lives

Abstract

The testes develop in the abdomen and descend during the third trimester into the scrotum. The testicle can be arrested anywhere during its descent or it can migrate into an abnormal position. Undescended testis, otherwise known as cryptorchidism, is a well-described disorder with a spectrum of complications ranging from torsion to necrosis, infertility, and atrophy. The risk of developing testicular cancer in an undescended testicle has been well-documented, as high as 32 times the general population if the testicle is not brought down before the age of 12. In clinical practice, surgical exploration for the testicle and definitive fixation in the scrotum is warranted at age two to three if it fails to descend to the normal position, with clinical success rate of 90%. However, the problem with an undescended testicle arises when surgical exploration is negative, and the usefulness of other approaches, including imaging tests, in this setting is not clearly established. We report a case of a 45 year-old man with history of undescended left testicle diagnosed at birth, and repeated negative surgical explorations presenting with symptomatic pelvic mass, and eventually diagnosed with testicular tumor. This case highlights the potential difficulty in establishing this diagnosis despite the generally favorable outcomes with orchiopexy. Given its high prevalence, testicular neoplasm must be included in the differential diagnosis of patients with a history of an undescended testicle who present with an acute abdomen. Surgical resection without pelvic lymph node dissection is the standard of care for an abdominal testicle found at exploration.