Cryptorchid Testes Research Articles

Strangulated Interstitial Hernia with Strangulated Cryptorchid Testis-First Case Report in the Medical Literature.

Interstitial hernias are a rare subtype of abdominal hernias, where sac is present in between the abdominal wall layers. Although, difficult to diagnose clinically, they are usually detected on imaging studies. Interstitial hernias presenting with undescended testis are common. Even after a meticulous online search of the medical literature, we could not find a case report of 'Strangulation of Interstitial hernia, with a strangulated undescended testis in an elderly man.We hereby present this extremely rare case, and possibly, this could be the first of its kind, case report in the medical literature. Our aim is to present a combination of rare presentations in an elderly cryptorchid person with strangulated interstitial hernia. A 65-year male patient presented with 4 days of pain abdomen and vomiting. He was having features of toxaemia. Ultrasonography revealed interstitial hernia with bowel loops. During surgery, gangrenous bowel loops with the sac between the interstitial planes, with strangulated cryptorchid testis, were found. Strangulated interstitial hernia in elderly cryptorchid person, leading to the strangulation of the undescended testis, is extremely rare, and this could be the first case reported in the medical literature.

Prenatal [Ultrasound] Diagnosis of Cryptorchid Testicles

The role of ultrasonography as a routine investigative test for diagnosing testicular pathologies (in-utero and postnatally) cannot be overemphasized. Undescended (cryptorchid) testis according to literature is prone to neoplastic transformation. Determination of fetal gender in-utero by ultrasound allows for sex determination albeit; its full ethical implication should be considered. 3D ultrasonography is affordable, ubiquitous, reproducible and ensures rapid evaluation of a wide array of testicular pathologies, early (coincidental) diagnosis is important to avoid complications (such as torsion, bleeding or malignant-mass-formation) thus; sonar imaging features as an indispensable tool. The case aims to document and highlight accidental detection (at 31 weeks gestational age) and expunge on the accuracy of ultrasonography in diagnosing cryptorchidism. There is sparse (Nigerian) literature on Undescended Fetal Testis (UDFT). This report used antenatal imaging as a clear descriptive evidence of faulty testicular descent with detailed examination of the fetal genitalia. Ultrasound examination during the 3rd semester allows for accurate cryptorchid diagnosis (prenataly).

The evaluation of blood concentrations of testosterone, 17β-oestradiol and anti-Mu¨llerian hormone in dogs with cryptorchidism and testicular tumours.

Cryptorchidism and testicular tumours are very common disorders in dogs genitalia. The aim of the present study was o obtain an overview of serum 17β-oestradiol, anti-Muellerian hormone (AMH) and testosterone levels in intact dogs compared to dogs with different testicular tumours and dogs with cryptorchidism. Testosterone, AMH and 17β-oestradiol concentrations were measured in peripheral and local spermatic venous blood in dogs with unilateral cryptorchidism (n=8), dogs with neoplastic testicular diseases (n=8) and in a control group of mature intact dogs (n=8). Results confirmed significantly higher concentrations of testosterone in local venous blood (control group: right testicle (RT) 46.23 ± 40.88 ng/ml and left testicle (LT) 50.76 ± 43.76 ng/ml; cryptorchid group: RT 23.91 ± 22.79 ng/ml and LT 10.52 ± 7.37 ng/ml; tumour group: RT 37.26 ± 25.26 ng/ml and LT 44.86 ± 19.03 ng/ml) (p<0.05) compared to their concentrations in peripheral blood (PB) in a control (4.92 ± 3.3 ng/ml) and in a cryptorchid group (0.89 ± 0.78 ng/ml), but not in the tumour group (11.37 ± 10.86 ng/ml). However, we have found increased level of testosterone in PB in the tumour group compared to its PB concentrations in the control or the cryptorchid group. Concentrations of AMH in PB observed in the cryptorchid group was 54.98 ± 30.07 μg/ml and in the control group was 6.49 ± 3.24 μg/ml (p<0.05). The same was observed in the case of local blood concentrations, which were significantly higher in the cryptorchid group (RT 51.92 ± 30.59 μg/ml; LT 46.33 ± 34.86 μg/ml) (p<0.05). We also observed high oestradiol concentrations in the cryptorchid group in both peripheral and local blood (PB: 30.86 ± 20.28 pg/ml; RT: 55.71 ± 34.7 pg/ml; LT: 78.99 ± 47.72 pg/ml), and even higher in the tumour group (PB: 52.46 ± 34.02 pg/ml; RT: 188.16 ± 132.67 pg/ml; LT: 297.14 ± 245.56 pg/ml). AMH has been shown to be a specific biomarker of gonadal tumours originated in Sertoli cells. It is also useful marker for confirmation of the existence of a functional cryptorchid testis. According to us, the scientific work dealing with a disorder of testicular descent in dogs, regarding the evaluation of sex hormones levels and the formation of the testes using modern diagnostic methods, significantly contribute to the clarification of some processes, leading to pathophysiological disturbances during this process.

The hematological parameters in testicular cancer

Abstract Although testicular cancer (TCa) is rare neoplasm that occurs in young men aged between 18 and 35 years. The risk factors are cryptorchidism, family history, and infertility. The aim of this study was to investigate the diagnostic efficacy of neutrophil to lymphocyte ratio for the diagnosis of TCa. The patients who underwent orchiectomy in our unit reviewed retrospectively. Age of the patients, the laboratory results and pathological reports were recorded. The neutrophil to lymphocyte ratio (NLR) was calculated as the neutrophil counts divided to the lymphocyte counts. The patients were divided into two groups according to the pathology record. The testicular malign neoplasms are included in group 1 and group 2 includes the patients who had cryptorchidism and atrophic testes without any malignancy and inflammation. For statistical analysis, student t test was used for comparing the data between groups and the area under curves were used for NLR, neutrophil and lymphocyte counts in the diagnosis of testicular malign neoplasms.There were 285 patients in the present study. The patients' age was between 10 and 90 with a mean age of 36.87 ± 11.83 and 37.24 ± 20.31 years in groups respectively.The neutrophil, white blood cell counts and NLR were significantly higher in group 1 and lymphocye count was lower in patients with testicular cancer with statistical significance. The area under curve was 0.645, 0.626, 0.578 for NLR, neutrophil and lymphocyte counts for the diagnosis of TCa. Mixed germ cell tumor was the most common histologic subtype with an incidence of 51.58%(n:65 patients) and seminomas were reported 37.30% (n:47 patients) of the patients. Testicular cancer has low incidence when compared the other urologic malignancies. There are only three tumor markers that include alpha-fetaprotein, human chorionic gonadotropin and lactate dehydrogenase for testicular cancer diagnosis. The current study showed Neutrophil to lymphocyte ratio (NLR) may be used as a biomarker for TCa. Further studies are needed to define the assocaiton between NLR and testicular cancer.

Association between RNA-binding protein Ptbp2 and germ cell injury in an experimentally-induced unilateral cryptorchidism murine model.

RNA binding protein polypyrimidine tract binding protein 2 (Ptbp2) as a key alternative splicing regulator for male germ cell development is well established. However, its expression levels and role in cryptorchidism testes tissues has not been explored. Additionally, the molecular mechanism of heat stress impacts the correct proliferation and differentiation of germ cells is unclear. To investigate whether changes in Ptbp2 expression are correlated with heat stress-induced germ cell injury in testicular tissue, we used a murine model of intraperitoneal cryptorchidism with surgical operation. Here we present compelling evidence that germ cells are severely damaged in mice with unilateral cryptorchidism, with non-obstructive azoospermia. And the Ptbp2 and Pgk2 mRNA levels were significantly decreased in parallel, leading us to conclude that the negative correlation between Ptbp2 levels and germ cell injury in unilateral cryptorchidism murine model. We hypothesize that Ptbp2 is susceptible to heat stress and its disruption has resulted in stability decline of germ cell transcripts Pgk2 mRNA, which consequently lead to germ cell injury in cryptorchidism testes. Thus, we confirm that Ptbp2 is an essential factor in heat stress-induced sperm cell injury and non-obstructive azoospermia.

DMRTC2, PAX7, BRACHYURY/T and TERT Are Implicated in Male Germ Cell Development Following Curative Hormone Treatment for Cryptorchidism-Induced Infertility.

Defective mini-puberty results in insufficient testosterone secretion that impairs the differentiation of gonocytes into dark-type (Ad) spermatogonia. The differentiation of gonocytes into Ad spermatogonia can be induced by administration of the gonadotropin-releasing hormone agonist, GnRHa (Buserelin, INN)). Nothing is known about the mechanism that underlies successful GnRHa treatment in the germ cells. Using RNA-sequencing of testicular biopsies, we recently examined RNA profiles of testes with and without GnRHa treatment. Here, we focused on the expression patterns of known gene markers for gonocytes and spermatogonia, and found that DMRTC2, PAX7, BRACHYURY/T, and TERT were associated with defective mini-puberty and were responsive to GnRHa. These results indicate novel testosterone-dependent genes and provide valuable insight into the transcriptional response to both defective mini-puberty and curative GnRHa treatment, which prevents infertility in man with one or both undescended (cryptorchid) testes.

Management of supernumerary testis

Polyorchidism is a rare congenital abnormality described as the presence of three or more testicles. We report the case of a 2-year-old boy with intermittent left-sided scrotal swelling and an ipsilateral undescended testis. During the operation, a left cryptorchid testis was found at the external ring, with further dissection revealing a second vas deferens attached to an additional intrascrotal testis. The cryptorchid testis was pexied in the left hemiscrotum with the second descended testis left in place. A review of the literature reveals over 150 cases of supernumeracy testis. Triorchidism is the most common form with the third testis typically located within the scrotal sac. Supernumeracy testis is frequently associated with undescended testis, testicular torsion, inguinal hernia, and hydrocele. Management is controversial with some advocating for orchidectomy due to concerns of malignancy. The family was educated about the risk for malignancy and the importance of regular follow-up and testicular self examination starting at puberty. Keywords: orchidectomy, orchidopexy, polyorchidism, supernumerary testis

Postnatal Germ Cell Development in the Cryptorchid Testis: The Key to Explain Why Early Surgery Decreases the Risk of Malignancy.

Cryptorchidism is a risk factor for testicular malignancy and surgical treatment lowers this risk. This study aimed to investigate the germ cell behavior in prepubertal cryptorchid testes using immunohistochemical markers for germ cell malignancy to understand how early orchiopexy may possibly prevent cancer developing. Histology sections from 1,521 consecutive testicular biopsies from 1,134 boys aged 1 month to 16.5 years operated for cryptorchidism were incubated with antibodies including antiplacental-like alkaline phosphatase (PLAP), anti-Oct3/4, anti-C-kit, and anti-D2-40. Oct3/4 and D2-40-positive germ cells are found throughout the first 2 years of life, with declining frequency thereafter. After 2 years, they should have disappeared and may indicate neoplasia. PLAP-positive cells were seen in 57 to 82% and C-kit-positive cells in 5 to 21% of cryptorchid testes between 4 and 13 years. Not until puberty did PLAP and C-kit-positive undifferentiated spermatogonial stem cells vanish. Only 0.3% of the present material had obvious prepubertal intratubular germ cell neoplasia (ITGCN) and they all had syndromic cryptorchidism. An additional three boys (0.3%) older than 2 years had weak Oct3/4 expression in undescended testes, but all cases were D2-40 negative. Prepubertal ITGCN was rare and mostly seen in syndromic cryptorchidism. In nonsyndromic cryptorchidism PLAP-positive undifferentiated spermatogonial stem cells persisted in a significant proportion of nontreated undescended testes and they will be especially sensitive to long-lasting abnormally high temperature that may be the single most important cause facilitating the accumulation of mutations during cell replication and the development of ITGCN to be prevented by orchiopexy.

Histological, cytogenetic and endocrine evaluation in twenty-five unilateral cryptorchid horses

ABSTRACTData from 49 horses (25 unilateral cryptorchid and 24 as control group) are reported to determine macroscopic and microscopic characteristics of the testes, as well as to characterize their karyotype and hormonal levels. Histology showed that only Sertoli cells were found in the lumen of the seminiferous tubules of the cryptorchid testes, while spermatogenesis in the scrotal testes resulted normal. Cytogenetic evaluation showed that all cryptorchid horses were normal males (2n = 64, XY). In addition, the lower testosterone production observed in cryptorchid horses was associated to the smaller size of the retained testicle as well as to the lower number of Leydig cells adjacent to the seminiferous tubules. This study confirmed that a simple determination of plasma testosterone levels was enough to differentiate between non-breeding stallions, cryptorchid and castrated animals, avoiding the administration of hCG.

Ghrelin modulates testicular damage in a cryptorchid mouse model.

Cryptorchidism or undescended testis (UDT) is a common congenital abnormality associated with increased risk for developing male infertility and testicular cancer. This study elucidated the effects of endogenous ghrelin or growth hormone secretagogue receptor (GHSR) deletion on mouse reproductive performance and evaluated the ability of ghrelin to prevent testicular damage in a surgical cryptorchid mouse model. Reciprocal matings with heterozygous/homozygous ghrelin and GHSR knockout mice were performed. Litter size and germ cell apoptosis were recorded and testicular histological evaluations were performed. Wild type and GHSR knockout adult mice were subjected to creation of unilateral surgical cryptorchidism that is a model of heat-induced germ cell death. All mice were randomly separated into two groups: treatment with ghrelin or with saline. To assess testicular damage, the following endpoints were evaluated: testis weight, seminiferous tubule diameter, percentage of seminiferous tubules with spermatids and with multinucleated giant cells. Our findings indicated that endogenous ghrelin deletion altered male fertility. Moreover, ghrelin treatment ameliorated the testicular weight changes caused by surgically induced cryptorchidism. Testicular histopathology revealed a significant preservation of spermatogenesis and seminiferous tubule diameter in the ghrelin-treated cryptorchid testes of GHSR KO mice, suggesting that this protective effect of ghrelin was mediated by an unknown mechanism. In conclusion, ghrelin therapy could be useful to suppress testicular damage induced by hyperthermia, and future investigations will focus on the underlying mechanisms by which ghrelin mitigates testicular damage.

The Nonpalpable Testis: A Narrative Review.

While the nonpalpable testis represents a small portion of all cryptorchid testes, it remains a clinical challenge for pediatric urologists. Controversy exists surrounding the best evaluation and management of this entity. In this review we update what is known about the nonpalpable testis, including the etiology, preoperative evaluation and best surgical management as well as novel techniques and ongoing controversies. We searched PubMed® and MEDLINE® from January 2000 to January 2017 using relevant key terms. Of 367 articles 115 were considered for inclusion based on a priori design. Using a narrative review format, an update on the evaluation and management of the nonpalpable testis including novel concepts and techniques was synthesized. The nonpalpable testis should be evaluated by physical examination only. Imaging is not indicated for routine cases. The optimal surgical approach and technique remain debatable but several novel techniques have been described. Due to the rarity of the nonpalpable testis, randomized controlled trials and other quality comparisons are difficult. Therefore, management remains controversial. Evaluation and management of the nonpalpable testis remain difficult, and some aspects are still debated. Future research should focus on multi-institutional collaborative trials to determine the optimal operative management.

Chances of Sperm Retrieval during Testicular Sperm Extraction in Adult Cryptorchid Testes

Chances of Sperm Retrieval during Testicular Sperm Extraction in Adult Cryptorchid Testes

Scrotal testis size in unilateral non-palpable cryptorchidism, what it can and cannot tell: Study of a Middle Eastern population

Predicting the fate of a unilateral non-palpable testis based on its scrotal counterpart has been recommended by some, yet disputed by others, and the question remains open. To investigate the accuracy of contralateral testis hypertrophy in predicting the absence of a unilateral non-palpable testis in a Middle Eastern population. This retrospective study included all patients referred to the present institution with unilateral non-palpable testis between June 2010 and August 2014, who had undergone laparoscopy. The scrotal testis was examined by sonography for size and volume, and diagnostic laparoscopy was utilized to determine the state of the cryptorchid testis. Of the 135 referred patients, 64 were aged ≤8 years, 29 were 9-18 years, and 42 were >18 years old. Diagnostic laparoscopy revealed 63 intra-abdominal testes, 20 small intra-inguinal testes, 32 vanished testes, and 20 nubbins or aplasia (Summary fig.). Scrotal testis volume was only a modest predictor for absence of the contralateral gonad in adult patients in whom a 22ml cut-off yielded 64.3% sensitivity and 92.9% specificity. For those aged <18 years, overall accuracy was poor and dropped below 60%. Relative enlargement of contralateral testis in decreasing order of size was observed in patients with primary monorchism, followed by those with secondarily atrophic or nubbin testis, and then those with normal sized inguinal or abdominal testis. Unlike some previous series, which based their conclusions upon open exploration and mostly studied pre-pubertal subjects, the present results exclusively from laparoscopic exploration suggested that contralateral testis volume is a poor and inconsistent predictor of monorchism in children, and marginally predictive for young adults with unilateral non-palpable testis. This study comprised a reasonably large overall sample size compared with preceding reports; however, the number of patients within in each age group was limited. Greater numbers could allow for statistical comparison stratified by age group, for which this study was not powered. Contralateral testis volume predicts, with modest accuracy, monorchism in adults with unilateral non-palpable testis. In younger patients, the overall predictive accuracy of scrotal testis size is poor and not consistently dependable.

Antioxidants: A therapy for cryptorchidism, true or false?

BACKGROUND: Cryptorchidism remains a common congenital anomaly of the male genitalia, affecting 2.4%–5% of male infants. AIM: This study investigates the effects of L-carnitine (LC), Biotin, and Vitamin D3 (Vit D) on the cryptorchid testis in Sprague-Dawley (SD) rats. MATERIALS AND METHODS: Twenty-five adult male SD rats were divided into 5 groups of 5 each. The right testis of all rats was made cryptorchid. Group A received distilled water, Group B received LC, Group C received biotin, and Group D received Vit D while Group E received a cocktail of LC, Biotin, and Vit D. At the end 8 weeks, the animals were euthanized, and vital organs obtained, processed, and analyzed. RESULTS: The testis of the untreated animals had marked depletion in the cells of the seminiferous tubules compared to those treated with antioxidants. They also had upregulated levels of malondialdehyde (MDA) which was inversely proportional to the levels of antioxidant enzymes. Epididymal sperm quality and testosterone level were also reduced in the untreated cryptorchid animals. These effects were, however, mitigated by the use of the antioxidants. CONCLUSION: In this study, antioxidant therapy acted as a panacea for reversal of reactive oxygen species-induced male infertility in cryptorchid testis in SD rats. Further studies on antioxidants in comparison with hormonal supplements and surgical treatments of cryptorchid testis will be of great significance.

A Rare Variant of Inguinal Hernia: Cryptorchid Testis at the Age of 60: An Unusual Case Report

Cryptorchidism is characterized by the extra-scrotal position of the testis. Although inguinal hernia is frequent, cryptorchid testis at the age of 60 years is an uncommon entity. We wish to present this extremely rare case of inguinal hernia, which is the first one that we have encountered in our practice, along with the accompanying prognosis and therapeutic issues and a review of the literature.

Leydig cell clustering and Reinke crystal distribution in relation to hormonal function in adult patients with testicular dysgenesis syndrome (TDS) including cryptorchidism.

Testicular dysgenesis syndrome (TDS) comprises testicular germ cell cancer, cryptorchidism and some cases of male infertility and hypospadias, which can be linked to impairment of intrauterine gonadal development. Among histological signs of TDS, large Leydig cell (LC) clusters (micronodules) are frequently present. This study aimed to investigate possible associations of LC micronodules with the presence of Reinke crystals and hormonal function of LCs, the latter primarily reflected by serum concentrations of luteinising hormone (LH) and testosterone, in patients with TDS. A retrospective study of 101 andrological patients with TDS (infertility with and without a history of cryptorchidism or presence of germ cell neoplasia in situ) and 20 controls with normal testis histology and LC-function. Archived testicular biopsies were re-evaluated for the presence of LC micronodules and Reinke crystals and the findings were correlated with testis size and serum concentrations of LH, follicle-stimulating hormone (FSH), testosterone, inhibin B, estradiol and sex hormone binding globulin (SHBG). TDS patients with bilateral LC micronodules had significantly lower concentrations of LH, FSH and inhibin B, a lower testosterone/LH-ratio and smaller testis sizes compared to TDS-patients lacking this feature. Presence of LC micronodules was correlated with a lower number of Reinke crystals, while cryptorchid testes had a significantly higher number of crystals than normally descended TDS testes. LC micronodules appear to be a compensatory mechanism caused by androgenic failure and are presumably driven by high concentrations of LH. A relative paucity of Reinke crystals in LCs within micronodules in normally descended TDS testes may be a feature of recently renewed immature Leydig cells. The increased number of Reinke crystals in LCs in testes that were either undescended at birth or are persistently undescended could indicate an impairment of LC renewal in cryptorchidism.

Positive Oct -3/4 and D2-40 Immunohistochemical Expression in Germ Cells and Suspected Histology Pattern of Intratubular Germ Cell Neoplasia in Boys with Cryptorchidism Vanish after the Age of 2 Years.

Introduction Intratubular germ cell neoplasia (ITGCN) is a precursor to testicular germ cell cancer. Adult germ cell cancer immunohistochemical markers may fail to detect ITGCN in prepubertal boys with congenital cryptorchidism, because positive immunohistochemistry is commonly seen in boys younger than the age of 2 years, where most orchiopexies are performed. The aim of the study was to evaluate the diagnostic challenge to differentiate between a histological pattern of ITGCN and a histological pattern with some atypical germ cells and all positive cancer immunohistochemical markers, but no increased risk of malignancy. Materials and Methods Histology sections from 373 testicular biopsies from 289 boys aged 1 month to 2 years operated for cryptorchidism were incubated with primary antibodies including anti-placental-like-alkaline phosphatase, antiOct-3/4, anti-C-kit, anti-D2-40, and in case of repeat biopsy with anti-stem cell factor (SCF) receptor. Results The prevalence of Oct-3/4 and D2-40-positive staining of germ cells in testicular biopsies were in age groups less than 6 months, 100% and 50%; 6-12 months, 60% and 17%; and 1-2 years, 12% and 4%. A 1 year, 1-month-old boy with Prader-Willi syndrome treated with growth hormone had ITGCN in both cryptorchid testes. In another three bilateral nonsyndromic cases, 8 months, 8 months and 1-year-old, a histological pattern in accordance with ITGCN was found. These three boys had a repeat biopsy from both testes performed at the age of 3 years, 4 months, 3.5 years, and 3 years, 10months, respectively. In all cases, the Oct-3/4 and D2-40 positive germ cells turned negative and the histological pattern normalized completely. The primary biopsies had SCF negative germ cells. Conclusion This study is valuable in identifying the age-related change in Oct-3/4 or D2-40 immunopositive germ cells in seminiferous tubules. An ITGCN-like histological pattern in nonsyndromic cryptorchidism will vanish after the age of 3 years. Even when immunohistochemistry is applied, prepubertal ITGCN is so rarely demonstrated in cryptorchid testes, that it is not plausible that ITGCN generally originates during fetal development in cryptorchidism.

The diagnostic impact of testicular biopsies for intratubular germ cell neoplasia in cryptorchid boys and the subsequent risk of testicular cancer in men with prepubertal surgery for syndromic or non-syndromic cryptorchidism

IntroductionCryptorchidism is a risk factor for testicular cancer in adult life. It remains unclear how prepubertal surgery for cryptorchidism impacts later development of adult testicular cancer. The aim of study was to investigate tools to identify the cryptorchid boys who later develop testicular cancer. MethodsThe study cohort consisted of 1403 men operated prepubertally/pubertally for undescended testis between 1971 and 2003. At surgery testicular biopsies were taken from the cryptorchid testes. The boys were followed for occurrence of testicular cancer. The testicular cancer risk was compared to the risk in the Danish Population. Testicular biopsies from the boys who developed testicular cancer during follow-up underwent histological examination with specific diagnostic immunohistochemical markers for germ cell neoplasia. ResultsThe cohort was followed for 33,627 person years at risk. We identified 16 cases with testicular cancer in adulthood. The standardized incidence ratio was 2.66 (95% CI: 1.52–4.32). At time of primary surgery in prepubertal/pubertal age Intratubular Germ Cell Neoplasia (ITGCN) was diagnosed in 5 cases and the boys were unilaterally orchiectomized. At follow-up new immunohistochemical staining indicated ITGCN in two of the 16 cancer cases at reevaluation of the original biopsies from time of prepubertal/pubertal surgery. One had syndromic cryptorchid and developed seminoma, and another showed nonsyndromic cryptorchidism and developed embryonic teratocarcinoma. Totally, ITGCN was diagnosed in 0.5% (7/1403) of prepubertal cryptorchid boys, whereof 57% (4/7) in syndromic-cryptorchidism. DiscussionITGCN is predominantly observed prepubertally in boys with syndromic-cryptorchidism. In nonsyndromic cryptorchidism testicular cancer develops postpubertally, generally not based on dormant germ cells of ITGCN caused by an early fetal maldevelopment. Levels of EvidenceLEVEL I.

Fetus-in-fetu presenting as a cryptorchid testis and abdominal mass: A report of a case and review of the literature

Abstract Fetus-in-fetu is a rare congenital tumor containing fetal tissue with an unclear etiology, but some believe it to arise from a parasitic monozygotic twin within the host twin. We present the case of a 3-week old term neonate found to have an abdominal mass and undescended right testicle. At laparotomy, a large, circumscribed mass was present in the right upper quadrant. It was found to be associated with the vas deferens and gonadal vessels, appearing to be closely associated with the right-sided cryptorchid testis. Pathology revealed an intratesticular fetus-in-fetu. Fetus-in-fetu is a rare condition where a well-developed mass believed to arise from a monozygotic, parasitic twin, is found within its sibling. First reported by Dr. Meckel in 1800, this is thought to occur in 1 in 500,000 live births with less than 100 cases reported in the literature. Fetus-in-fetu is differentiated from mature teratoma by the presence of an axial skeleton with metameric segmentation and well-differentiated tissues. FIF is a benign disease, however surgical excision continues to be the treatment of choice, in order to confirm diagnosis by pathology and to exclude malignant teratoma. Fetus-in-fetu is a rare of congenital lesion that can present as an abdominal mass. Due to the high prevalence of retroperitoneal location, a FIF should remain on the differential for an infant with an abdominal mass and ipsilateral cryptorchid testis.

A rare cause of acute abdomen – the torsioned intra abdominal testicular tumor

Cryptorchidism is a developmental defect in which the testes fail to descend completely into the scrotum. Isolated cryptorchidism affects 3% of full-term male newborns. True undescended testis is unilateral in 80% cases. Approximately 70- 77% of cryptorchid testes will spontaneously descend, usually by 3 months of age. Approximately 10% of testicular tumors arise from undescended testes. The higher the position of an undescended testis, the greater is the risk for development of malignancy. Almost half of the tumors that occur in testes are located abdominally, with 6-fold higher frequency than in an inguinal testis. The most common tumor that develops from the cryptorchid testis is the seminoma. Complications of intraabdominal testis such as torsion, rupture and bleeding are rare 1 .