Ectopic Testis Research Articles

Perineal discomfort caused by the sitting position as a rare manifestation of ectopic testicle: About two cases

Background and importancePerineal ectopic testis (PET) is a rare congenital anomaly; the diagnosis is typically made by conducting a physical examination of the ectopic areas and noting an empty scrotum on the corresponding side. We report two pediatric cases of PET in whom this condition was diagnosed by a discomfort induced by the sitting position. Cases presentationTwo cases of PET were operated on in our pediatric surgery department over the past three years. Patients were referred for perineal discomfort in the sitting position. Children had difficulty staying seated at home or school, this was described by parents as an abnormal fussiness after sitting. The age at diagnosis was five and three years. The diagnosis of perineal testicular ectopia was made through physical examination. Orchidopexies to the corresponding scrotum were performed in both cases via an inguinal approach. No postoperative complication was noted with a follow-up of 24 months. Clinical discussionPET is typically diagnosed through clinical examination, characterized by an empty scrotum and a palpable perineal mass. The exact aetiology is unclear, but it involves abnormalities in testicular descent mechanisms, particularly the gubernaculum. PET can cause perineal discomfort when sitting, a symptom observed in the two pediatric cases presented. Early surgical intervention via orchidopexy is crucial to prevent complications. Both reported cases were successfully treated with no postoperative complications and resolution of discomfort. Prompt diagnosis and treatment are essential for preserving testicular function. ConclusionPerineal discomfort on sitting was the defining diagnostic element in our cases. In practice, this symptom should be a prompt for a thorough perineal examination in children with an empty scrotum. However, the patient's age and ability to express himself determine the significance of the symptom.

Novel Technique of Managing an Ectopic Hemiscrotum and Testis.

Novel Technique of Managing an Ectopic Hemiscrotum and Testis.

'Testicular masquerade': a case report of testicular malignancy with persistent Müllerian duct syndrome and transverse testicular ectopia.

Persistent Müllerian duct syndrome (PMDS) is a rare sexual development disorder. It is even more rarely associated with transverse testicular ectopia (TTE), a rare form of testicular ectopia, in which both testes descend through a single inguinal canal and are present in the same hemiscrotum. PMDS with TTE is associated with 18%-33% malignant transformation. Here we report the case of a 48-year-old man who presented with a large right inguinoscrotal swelling and on evaluation was found to have a large right testicular mass with complete right inguinal hernia, undescended left testis and a central abdominal mass. On evaluation with contrast-enhanced computed tomography abdomen and pelvis and image-guided biopsy he was diagnosed with mixed germ cell tumour of the right testis (predominantly a seminoma) with a retroperitoneal nodal mass and absent left testis, for which he received chemotherapy. Post-chemotherapy he underwent surgery and was diagnosed intraoperatively with PMDS along with TTE and testicular malignancy arising from the ectopic left testis. Postoperative recovery and follow-up were uneventful. Most cases of PMDS are diagnosed early in life. They present clinically with unilateral or bilateral undescended testis with inguinal hernia. In adults, PMDS is usually associated with male infertility. However, TTE is associated with an increased risk of testicular tumours if undiagnosed until adulthood. In adults PMDS with TTE is usually an intraoperative finding and is commonly associated with malignancy in the ectopic/undescended testis.

Pre-germ cell neoplasia in-situ in a patient with complete androgen insensitivity syndrome

Abstract Introduction/Objective Complete androgen insensitivity syndrome is a disorder of sex development in 46, XY individuals with external female genitalia and undescended testes, often presenting with inguinal hernia in infancy and/or primary amenorrhea in adolescents. Given the increased risk for the development of germ cell neoplasms in the ectopic testis, early gonadectomy or orchidopexy may be indicated. Methods/Case Report We report a 21-year-old patient assigned female at birth (46, XY) with a history of bilateral inguinal hernia repairs (age 2) and later with lack of menarche (age 16). Additional work-up showed an elevated testosterone level (394 ng/mL) and normal luteinizing and follicle stimulating hormone values. On pelvic ultrasound, retained intraabdominal gonads were identified, but female sex organs were absent. During a gonadal relocation procedure, the gonads appeared irregular in shape with multiple cysts and small nodules, and bilateral gonadectomy was performed. Grossly, the gonads measured 4.9 and 4.3 cm with a smooth external surface and a lobulated cut surface with multiple cysts, up to 1.6 cm, containing clear, serous fluid. Histologic sections showed most seminiferous tubules were lined only by Sertoli cells with only occasional spermatogonia. Leydig cell hyperplasia and areas of ovarian-like stroma were seen. OCT4 immunostain highlighted the nuclei of individually disposed germ cells in the base of tubules (singly dispersed, non-linear pattern), raising concern for germ-cell neoplasia in-situ (GCNIS). However, the histology and staining pattern were better interpreted as diagnostic of germ cells with delayed maturation and pre-GCNIS. Additionally, OCT4 showed rare single cells within the stroma and considered to represent residual undifferentiated gonadal tissue. After gonadectomy, the patient was started on hormone replacement therapy. Results (if a Case Study enter NA) NA Conclusion This case highlights the potential pitfalls in the interpretation of OCT4 immunostain to avoid misdiagnosis of germ cell neoplasia.

Ectopic Testis, Pubo-Penile: A Rare Entity

Background: Pubo-penile ectopic testis is a rare congenital anomaly in which the testis is situated along the penile shaft or along its root. We are reporting a rare case of penile testicular ectopia whose etiopathogenesis is poorly understood. We describe one case of Pubo-penile ectopic testis in a Eleven-years-old child. The diagnosis was made on physical examination alone. The condition was present since birth but child presented late and successfully treated.
 Clinical Description: 9 yrs old male child presented with swelling along base of penis since birth. On examination, left hemi-scrotum was empty with poorly developed scrotal sac. External genitalia was normal and appropriately developed. There was a single, firm, well defined, non-tender, mobile, oval shaped swelling of size 3.5 X 2.5cms, palpable at the base of the penis. Right sided testis was normally placed in scrotum. Testicular sensations were intact.
 Management: Ultrasound abdomen and inguino-scrotal region was done & it confirmed the ectopic location of the testis. Incision was given over the swelling at the base of penis to mobilise the testis along with spermatic cord and it was taken through the superficial ring in to the scrotum by small inguinal incision. Orchidopexy was done & testis was anchored in the left extra dartos pouch. Postoperative period was uneventful and child was doing good in follow-up.
 Conclusion: Pubo-penile ectopic testis is rare. Examination of a child with an empty scrotum should include examination of all potential ectopic sites. The diagnosis is based on physical examination. Treatment is surgical and long-term prognosis is excellent.

Perineal Ectopic Testis in One and A Half Year Old Child As A Rare Congenital Anomaly: A Case Report

Ectopic testis is described as an abnormality of testicle development in which one or both testicles aren’t descending through the testicle normal pathways. Among all newborns with undescended testis, only 1% are diagnosed as ectopic testis. In this case, an 18 months old boy was presented to hospital with chief complaint of impalpable testis dextra. Phsical examination showed the right testis was not palpable in the scrotum and perineum. Ultrasonography examination showed a right testis in the perineum with normal volume and vascularization. Right orchidopexy was performed to correct the location of the testis. Early diagnostic of ectopic testis must be done through anamnesis, physical examination, and advanced examination. Limited faciliiesy and lack of parental knowledge make the patients come late to health facility. The conclusion of this study is knowledge among parents and skills of health workers concerning congenital anomaly especially undescensus testis should be improved.

Intrascrotal Incision: An Alternative Technique for the Management of Inguinoscrotal Pathologies, Experience from 76 Cases

Abstract Introduction The aim of this clinical study was to present our experience gained by using the intrascrotal incision through the mid raphe for the management of a variety of inguinoscrotal pathologies. Materials and Methods A total of 76 male patients, between 2 and 16 years, underwent surgical treatment through a mid raphe intrascrotal incision, for a wide range of inguinoscrotal diseases, including torsion of the spermatic cord, torsion of the testicular appendages, non-communicating hydrocele, communicating hydrocele, ectopic testis, retractile testicles, palpable undescended testis, testicular trauma and testicular prosthesis placement. Results All the patients had an uneventful postoperative recovery, with none mentioned complication, and none of them required convention to the traditional inguinal method. The follow-up examination ranged from 6 months to 3 years, with no surgical complication highlighted. Conclusions We recommend that the intrascrotal incision through the mid raphe may be considered as an alternative technique to inguinoscrotal pathologies, instead of other approaches. The ability to treat a variety of pathologies regarding both two hemi-scrotums and the inguinal region at the same time, the provision of adequate surgical site, while succeeding much less dissection and disruption of tissue, the excellent cosmetic result, the greater comfort for the ‘day-case’ child, the ability to use the scrotal septum in order to fix the testis in the scrotum and the avoidance of an extra incision are the main advantages of the intrascrotal incision.

Efficiency of immunocastration with an anti-gonadotropin-releasing hormone vaccine on cryptorchid bulls.

Cryptorchid bulls have low economic value owing to the effects of masculinization. Moreover, surgical removal of an ectopic testis is difficult in certain clinical cases. Recently, immunocastration has garnered popularity as a nonsurgical castration method in pig farming; however, the effects of immunocastration on cryptorchid bulls are yet to be yet. Herein, we investigated endocrine changes due to immunocastration in cryptorchid bulls and studied its effectiveness. This study included 13 Holstein bulls diagnosed with cryptorchidism and classified into two groups based on pubertal period: <8 months of age (pregroup) and ≥8 months of age (postgroup). Antigonadotropin-releasing hormone (GnRH) vaccine was used for immunocastration, and two vaccine doses were administered. Blood testosterone and anti-Müllerian hormone (AMH) levels were measured and analyzed for endocrine evaluation. The testosterone levels significantly decreased following the start of immunocastration in both groups, thereby confirming the efficacy of antiGnRH vaccination in cryptorchid bulls. The AMH levels significantly increased in the pregroup with two antiGnRH vaccination, suggesting a compensatory response via the neutralization of GnRH antibodies. The AMH levels did not significantly change in the postgroup, indicating the partial suppression of AMH secretion in Sertoli cells during sexual maturation and failure of Sertoli cell maturation. Thus, we successfully restrained the serum testosterone levels in cryptorchid bulls using antiGnRH vaccine. The testosterone levels are a useful indicator of the immunocastration effect on cryptorchid bulls. Hereafter, a vaccine program that can sustain the castration effect on cryptorchid bulls is necessary.

Management of undescended testes in adolescents and young adults

Background: The undescended testes (UDT) are at risk of torsion, trauma and pathologic changes leading to subfertility and malignant transformation. Surgery for UDT should be performed before the age of 2 years.Methods: This was a 5-year retrospective study conducted on patients who presented with features of UDT in Port Harcourt. Ethical approval for the study was sought and gotten from the hospital ethical committee. Data was obtained from ward admission registers, theatre, and discharge records. The information gotten included history, examination findings and treatment received. Patients who had ectopic testes, retractile testes and incomplete records were excluded from the study. The information was collected and analysed. Categorical data was presented in the form of frequencies and percentages using tables. Continuous variables were presented in means and standard deviation. Results were presented in tables and charts.Results: The 15-19-year age group had the highest frequency. The median age was 19 years. Most subjects had at least secondary school education (71.43%). The right testes alone were undescended in 11 cases while the left alone was undescended in 7 cases. Three patients presented with undescended testes. Most (15) patients had their testes located in the inguinal canal. Poverty was the most common reason for late presentation. Orchidopexy was most commonly carried out via an inguinal approach.Conclusions: Late presentation of patients with UDT is common. Inguinal orchidopexy was the most common surgery performed. Health education on the need for scrotal examination after birth can aid earlier presentation.

Subcutaneous Lipoma Mimicking Irreducible Inguinal Hernia

Inguinal or groin region is an area of diagnostic mysteries. It is usually associated with a painless or painful swellings. Swellings in this area can be congenital or acquired, acute or chronic, single or multiple, soft to hard, mobile to immobile and appear suddenly or gradually. Commonest swelling in this region is a simple direct or indirect inguinal hernia in children and adults with a positive cough impulse. The next common lump is a femoral hernia, hydrocoele, sebaceous cyst or an enlarged reactive or malignant lymph node. Other uncommon Differential diagnosis includes ectopic testes, funiculitis, femoral artery aneurysm, pseudoaneurysm, hidradenitis, epididymitis, varicocele and abscess. Subcutaneous lipoma is a rare condition which can mimic a diagnosis of irreducible indirect inguinal hernia and other diagnostic problems for the attending physicians. We present a case of groin lipoma mimicking irreducible right sided indirect inguinal hernia in young healthy man.

Scrotal orchidopexy for perineal ectopic testis

Perineal ectopic testis (PET) is a rare form of testicular migration abnormality. We report a case of neonatal PET diagnosis and early management. In reported cases, diagnosis is often late, well after the age of 1 year, and surgery is conventionally performed by an inguinal and scrotal approach. Here, surgery consisted of scrotal orchidopexy, with placement in the dartos, at the age of 6 months. Follow-up was uncomplicated. This approach has not been reported for this form of ectopy, but seems perfectly suitable. There is no advantage to delaying the treatment of this type of ectopy.

A RARE CASE OF PERINEAL ECTOPIC TESTIS

In Perineal ectopic testis (PET), the testis is located between the penoscrotal raphe and genitofemoral fold. PET incidence is &lt; 1% of all undescended testis. It is a rare congenital anomaly. This article reports a case of an inguinal orchidopexy of the ectopic testis on a male patient aged 9 year presenting a right testicle located in right perineum. Examination of patient with empty scrotum (maldescent testes) should include examination of sites like perineum to look for ectopic testis.

A PRESENTATION OF TRANSVERSE TESTICULAR ECTOPIA – A CASE OF UNILATERAL DOUBLE TESTIS

Testicular Ectopia is an extremely rare anomaly in which deviation of testis descent in unilateral location of both testis. It is usually associated with an inguinal hernia with spermatic cord of the ectopic testis originating from the appropriate side. We report a case of U/L double testis presented with an inguinal hernia in a 26 year old male patient.

Perineal ectopic testis in adult: Experience from tertiary hospital, northern Tanzania

Introduction and importancePerineal ectopic testis is a rare congenital abnormality mostly diagnosed during childhood period. The diagnosis can be easily reached by physical examination. The treatment of choice is either orchidopexy or orchiectomy through scrotal or inguinal approach.Case presentationWe report a case of 30 year old male with painful perineal mass and empty right hemiscrotum. Ultrasound of the mass was done prior to operative procedure and the ectopic testis was the working diagnosis ever since. At exploration there was no abnormality found on the testis; thus, orchidopexy was done with uneventful postoperative period.Clinical discussionEctopic testis is rare congenital anomaly with perineal ectopic testis accounting for only 1% of all cases. Most cases of ectopic testis are diagnosed during childhood period. Our case presented at the age of 30 years, the reason could be either late diagnosis by physician or lack of insight of parents/care takers or both. The late presentation might pose a diagnostic challenge but also the testis may be atrophic or undergo malignant changes. In this case the testis was normal and therefore it was successfully relocated surgically through trans-inguinal approach.ConclusionIt is suggested to make perineal ectopic testis one of the differential diagnoses on painful perineal swelling without ipsilateral testis on any man.

Ring chromosome 9 and chromosome 9p deletion associated with neurological and malformative syndrome

Ring chromosome 9 is a rare chromosomal abnormality. The severity and nature of symptoms vary according to the structural abnormalities. Here, we report a case of a patient with neurological and malformative syndrome caused by a ring of chromosome 9 associated with partial 9p deletion. The 1-year-old child had a general hypotonia at birth regressed to peripheral hypotonia and normal axial tonus, psychomotor retardation, weight retardation, microcephaly and trigonocephaly, facial dysmorphia, flattened neck, abnormal nipple spread, dorsal kyphosis, white line hernia, ectopic testis and cardiac malformation cured at the age of 1 year, no other signs detectable. The standard constitutional karyotype revealed a ring of chromosome 9 with a deletion of the region pter-22p: 46,XY,r(9)(p22;q34). The chromosomal abnormality was homogeneous. The genetic counseling remains incomplete due to the absence of the parents’ karyotype. The cardinal traits reported in the ring chromosome 9 and chromosome 9p deletion syndrome were observed in our patient such as hypotonia, psychomotor retardation, microcephaly and trigonocephaly. Indeed, the deleted region contains numerous genes involved in the neurological manifestations and cranial dysmorphia including: CER1, FREM1, NFIB, GLDC, VLDLR, FOXD4, SMARCA2 and KANK1. Microarray analysis is important in order to detect the deleted segment and thereby the deleted genes.&#x0D; The ring chromosome 9 is characterized by a genotype heterogeneity and a phenotype variability that can be due to multiple factors: loss or gain of genetic material, mitotic disruption, ring chromosome instability. Genotype-phenotype correlation could provide reliable information for genetic diagnosis, genetic counseling and clinical management.&#x0D; &#x0D; Keywords: Chromosome 9, Ring, Deletion, Phenotype, Genotype.

INGUINOSCROTAL SWELLINGS IN CHILDHOOD: A CLINICO-DIAGNOSTIC APPROACH TO DIFFERENTIAL DIAGNOSIS

BACKGROUNDS: Inguinoscrotal illnesses are one of the commonest gathering of problems seen in clinical careful practice. A wide scope of swellings are found around here in youngsters and incorporates hydrocele, twist testis, ectopic testis, lymphadenopathy, inguinal hernias, sores, epididymitis, orchitis, cancers and so on Careful clinical and radiological assessment of inguinoscrotum for changing infections helps in appropriate determination and careful administration of its differential analysis. METHOD: The current review was directed as an observational review over a time of 10 months and enlisted a sum of 50 patients. RESULTS: In this review, 31 cases had hydrocele, 14 cases had inguinal hernia, 2 cases had epididymorchitis, 2 cases had lymphadenopathy and one case had idiopathic scrotal edema. Individual sicknesses had changing introductions, clinical discoveries and post-usable discoveries. CONCLUSIONS: There is a shifting wide range of swellings in the inguinoscrotal area in youthful male kids. It was inferred that legitimate clinical and radiological assessment of the patient serves to opportune analyze the sickness and henceforth help in distinguishing right way to deal with the administration of the case.

Scrotoschisis in a Central African Newborn

Scrotoschisis, a rare congenital disease, is defined by an extracorporeal ectopic testis eviscerated as a result of a scrotal wall defect. We report a case in a Central African newborn, born via vaginal delivery, to non-consanguineous parents, admitted at three days of life from a level II health center. The pregnancy was poorly monitored without ultrasound. On admission, the temperature was 40ºC, he was polypneic and tachycardic. There was a congenital defect of the scrotal wall with exteriorization of the left testis and the right testis was normal. The blood count showed pancytopenia and the blood culture isolated amiklin-sensitive Klebseilla pneumonia. The diagnosis of scrotoschisis associated with sepsis was made. A tri-antibiotic therapy associated with general resuscitation followed by testicular transposition and orchidopexy performed on the eleventh day of life did not prevent the fatal outcome three hours after the surgery. This observation confirms the rarity of the malformation and the benefit of an early management.

Inguinal herniotomy in children: Retrospective three decades experience

Context: Inguinal herniotomy is the most frequently performed operation in the pediatric age group. The clinical outcome of inguinal hernias and hydroceles in pediatric patients should be assessed periodically. Aims: This study aims to analyze the clinical presentation and outcome of a large series of pediatric inguinal hernias and hydroceles from a tertiary care institute. Settings and Design: A retrospective study performed on cohort of pediatric patients with inguinal hernias and hydroceles from January 1983 to December 2014. Subjects and Methods: Pediatric patients, aged <16 years with inguinal hernias and hydroceles were studied. Results: There were 8000 pediatric patients with 7350 (91.875%) males and 650 (8.125%) females (M:F = 11.3:1). Only 60 (0.75%) were in neonatal age group and 1770 (22.125%) were infants. Out of 8000, 170 (2.125%) patients presented with incarcerated inguinal hernia. A total of 8260 herniotomies were performed which included 260 cases with bilateral disease. Inguinal hernia constituted 6195 (75%) patients and hydrocele in 2065 (25%) cases. Associated genital anomalies and abdominal wall defects were present in 252 (3.15%) cases. In 80 (1%) patients, additionally ipsilateral orchiopexy were performed for unilateral undescended testis in 76 (0.95%) patients and unilateral ectopic testis 4 (0.05%) patients. Postoperative complications were present in 48 (0.6%) cases. Conclusions: Complications associated with inguinal hernias including those presenting with incarceration and strangulation are rare if they are managed in time and under the supervision of an experienced pediatric surgeon. We recommend a yearly clinical audit (assessment of morbidity and mortality statistics) of pediatric inguinal hernias and hydroceles managed with inguinal herniotomy.

The Raveenthiran Syndrome—Ectopic testis within Spigelian hernia: Few additional remarks

Journal of Neonatal Surgery is a peer-reviewed and open-access electronic journal. Only a few journals are being published on Neonatal Surgery especially from a developing country, which justifies the need of a new journal on this subject.

Safety and Efficacy of Laparoscopic Management of Intracanalicular Testes in Pediatrics.

Introduction: Undescended testis is a relatively common congenital anomaly in male children with a prevalence of 1%-2% in live births. Upon discovering an empty scrotum, it is important to determine whether the testis is palpable, ectopic, retractile, or nonpalpable. A canalicular or "emergent" testis is a peeping one that freely slides to and fro between the abdominal cavity and inguinal canal. It may be impalpable initially, but at a time, it emerges from the internal ring to be palpable when it is "milked" down (where it was concealed from detection). It is reported that 15%-40% of cryptorchidism are viable peeping/canalicular testis. The laparoscopic approach for treating intracanalicular undescended testes offers many advantages over open inguinal orchiopexy. It maintains the integrity of the inguinal canal and eliminates the need to divide the epigastric vessels during dissection. The ability to dissect the testicular vessels at a higher level would increase the vessel length available to bring the testis down to the scrotum without strain. The aim of this study is to present our experience and evaluate laparoscopic approach for management of intracanalicular testes regarding operative safety, efficacy, and postoperative outcomes. Patients and Methods: This is a prospective study conducted at Department of Pediatric Surgery, MCH Hospital, Bisha, Saudi Arabia and Pediatric Surgery Department, Al-Azhar University Hospitals, Cairo, Egypt, in the period from October 2018 to August 2020 to evaluate the safety and efficacy of laparoscopic orchiopexy for intracanalicular testis. Patients with retractile testes, ectopic testes, testes located distal to the external inguinal ring, and nonpalpable testes were excluded from the study. Results: The study was conducted on 62 male children with 70 intracanalicular (peeping) testes, with age range from 8 months to 48 months (mean age: 24 months). Among them, 26 cases (∼42%) were left-sided, 28 (∼45%) were right-sided, and 8 (∼13%) cases were affected bilaterally. Postoperatively, all testes maintained good size without postoperative hydrocele or inguinal hernia. One case (1.4%) required open redo-orchiopexy because of testicular re-ascent to the level of scrotal neck. Moreover, there was no evidence of testicular atrophy confirmed by postoperative ultrasonography. All patients had good satisfied cosmetic results obtained by parent's questionnaire at postoperative follow-up visits. Conclusion: Laparoscopic orchiopexy for management of (intracanalicular) undescended testes is safe, effective, less invasive, without disturbance of inguinal canal anatomy, and with better cosmetic results.