Intra-abdominal Undescended Testis Research Articles

English

Testicular feminization syndrome or androgen insensitivity syndrome is a rare inherited form of male pseudohermaphroditism that occurs in phenotypically normal woman with male karyotype (XY), with an incidence of 1:20,000-64,000 male births. The individual with complete form of this syndrome have female external genitalia while those with partial form have variable ambiguity of genitalia. The undescended testis may go into malignant transformation. The androgen insensitivity syndrome with malignant testicular disorder is very rare. A twenty-eight year old female was admitted to the hospital with the complaint of primary amenorrhea. Clinical and laboratory investigation revealed testicular feminization syndrome with seminoma developed from intraabdominal undescended testis. Primary removal of the mass and postoperative chemotherapy was treatment of choice for the patient.

Retroperitoneal mature cystic teratoma arising from intra-abdominal undescended testis in an adult

Teratomas are a type of germ-cell tumour which may contain embryological tissues from more than one germ-cell layer, usually occurring in the gonads. Primary retroperitoneal teratomas account for 1–11% of retroperitoneal neoplasms and are most commonly found in neonates and young adults. In the clinical literature, retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in adult males has been very rarely reported. We report a case of surgically proven retroperitoneal mature cystic teratoma arising from an intra-abdominal undescended testis in an adult male by multislice helical computed tomography and magnetic resonance imaging.

Radiology-Pathology Conference: mature teratoma arising from an intra-abdominal undescended testis in a 7-month-old infant

We report a rare case of an intra-abdominal testicular mature teratoma in a 7-month-old male infant presenting with a palpable abdominal mass and unilateral undescended testis. We describe the pathology, clinical presentation, and imaging findings of this entity. Clinical features accompanied by characteristic radiologic findings guide a provisional diagnosis that is confirmed by histologic analysis following surgical removal of the tumor. The pathogenesis and radiologic findings of testicular mature teratomas in the prepubertal population share many similarities to that of mature ovarian teratomas commonly seen in females of reproductive age. Awareness of this entity will permit the radiologist to suggest timely diagnosis and intervention when presented with a similar case.

Diagnostic and Therapeutic Management of Impalpable Testis in the Era of Laparoscopy

Undescended testis is one of the common urogenital abnormality encountered. Annandale was the first person to perform orchidopexyin 1877. At present single stage, Stephen-Flower�s staged, procedure is being carried out for impalpable intra-abdominal undescendedtestis with open and laparoscopy techniques with various modifications including testicular autotransplant. Cortesi et al1 were the first todo diagnostic laparoscopy for cryptorchidism in 1976. Jordan et al2 described laparoscopic orchidopexy in 1992. Since then laparoscopicmethod has been gaining popularity, with advances in the field of laparoscopy. In this study, recent articles of impalpable intra-abdominaltestis were reviewed to see the use of laparoscopy in the diagnosis and management.Conclusions: Diagnostic laparoscopy has become the gold standard for the diagnosis of impalpable testis. Laparoscopy for surgicalcorrection is gaining popularity in pediatric as well as adult group with more and more surgeons opting for laparoscopic treatment. It canalso benefit the patient and is logical if both diagnosis and surgical correction are combined at one time.3

A 2-year-old boy with a stage III yolk sac tumor occurring in an intra-abdominal retained testis

A major complication of retained testes is an occurrence of malignancy later in life. We, herein, report the case of a 2-year-old boy who presented with a huge yolk sac tumor with retroperitoneal lymph nodes metastasis that originated in a left intra-abdominal undescended testis. Computed tomography and magnetic resonance imaging showed a huge round tumor connecting to the left retroperitoneal lymph nodes with metastasis extending from the left pelvic region to the left renal hilum. The serum α-fetoprotein level was 36,528 ng/mL. The right abdominal tumor appeared to be a giant testis that had strangulated at the neck of the cord. The tumor had ruptured at the side of the left pelvic lymph node metastasis, and a yolk sac tumor was diagnosed from a histologic analysis of the resected specimens. Postoperative PEB chemotherapy was effective, and a complete surgical resection of the tumor was performed 3 months after the initial laparotomy. The pathologic findings showed fibrous tissue without any tumor cells. The patient has been doing well for 18 months after the radical operation. This case might be a coincidental association of a yolk sac tumor occurring in an undescended testis, which thus caused a delay in making an accurate diagnosis.

The imaging findings of CT in six cases with giant pure seminoma in intraabdominal undescended testis

Objective To assess the diagnostic capability of spiral CT for giant pure seminoma in intraabdominal undescended testis.Methods Spiral CT of 6 cases with pure seminoma of inabdominal testes as proved by surgery and pathology were analyzed.All patients were male,and the age ranged from 31 to 45 years old with the mean of 35.2 years old.Results All tumors were located along the path of testicular descent on CT images.The arterial-supply of tumors all came from the testicular artery ipsilaterally.The draining vein could be seen between the mass and inferior vena cava or left renal vein in 5 cases.Isolaterally spermatic cord was absent in the inguinal region.Isolateral kidney was shifted upward.CT scans typically demonstrated a unilateral,mixed solid and cystic mass,with areas of solid located at the lateral aspect and areas of necrosis at the medial aspect.Contrast-enhanced CT scan showed mild enhancement of solid areas and band-like septal enhancement in areas of necrosis.There is no evidence of calcification or fat within the mass.Conclusion Spiral CT proves to be a very useful preoperative imaging modality for the giant intraabdominal seminoma. Key words: Cryptorchidism; Seminoma; Tomography,X-ray computed

US–MR Imaging Correlation in Pathologic Conditions of the Scrotum

Ultrasonography (US) is usually the initial imaging modality for evaluation of pathologic conditions of the scrotum. However, magnetic resonance (MR) imaging can be useful as a problem-solving tool when sonographic findings are equivocal. MR imaging allows characterization of scrotal masses as intratesticular or extratesticular and can demonstrate various types of lesions and tissue, including cysts or fluid, solid masses, fat, and fibrosis. MR imaging may be of value when the location of a scrotal mass is uncertain or when US does not allow differentiation between a solid mass and an inflammatory or vascular abnormality. Gadolinium-enhanced MR imaging can help differentiate between a benign cystic lesion and a cystic neoplasm. Gadolinium-enhanced imaging can also be used to demonstrate areas of absent or reduced testicular perfusion, such as in segmental testicular infarct. Finally, MR imaging can demonstrate an intraabdominal undescended testis, which can be difficult to detect with US, and is superior to US in differentiation between an undescended testis and testicular agenesis.

Seminoma in undescended testis

A testicular carcinoma in intraabdominal undescended testis can mimic other mesenteric or retroperitoneal mass. The identification of pampiniform plexus draining the mass can play an important role in diagnosis of testicular carcinoma in undescended testis. We report a case of seminoma in intraabdominal undescended testis, draining into pampiniform plexus and thrombus within it.

Histopathology of the intra-abdominal testis

Purpose Intra-abdominal undescended testes are associated with a high risk of infertility and cancer. The aim of this study was to evaluate the progression of germ cell damage in this sub-group of cryptorchid boys. Material and methods The material included cryptorchid patients Results Germ cells disappeared from 18-months of age. Hereafter, the frequency of no germ cells at surgery increased with increasing age (p 0.2 ( = lower limit for later fertility), none more than 2.7 years old. Two intra-abdominal testes showed intratubular germ cell neoplasia. Conclusions We recommend surgery for cryptorchidism before the germ cells disappear, i.e. before 15-months of age; especially in bilateral cryptorchidism. In boys with intra-abdominal testes more than 3 years old the testes preserve no potential for fertility. In unilateral cases more than 3 years old with a normal contralateral testis in the scrotum the intra-abdominal testis should be removed.

A case of immature teratoma originating in intra-abdominal undescended testis in a 3-month-old infant

Teratomas in an undescended testis are rare in infants. This report was the youngest case of immature teratoma originating in intra-abdominal undescended testis. A 3-month-old infant with cryptorchism was seen because of an asymptomatic palpable mass in the right abdomen. Ultrasonography and computed tomography revealed a multicystic large tumor with focal calcifications in the right side and serum tumor markers within normal limits. Complete resection of the tumor was performed and the histopathological diagnosis was made as immature teratoma of the right testis. Because retroperitoneal lymph nodes metastasis was observed in 3-month follow-up postoperatively, retroperitoneal lymphadenectomy and chemotherapy including bleomycin, etoposide, and cisplatin were performed. Presently, the infant has been free of recurrence for 3 years. We suggest that nonpalpable testis should undergo a careful evaluation and prompt resolution and that the subsequent finding of an intra-abdominal mass should make us think on the possibility of intra-abdominal testicular germ cell tumor. Postoperative adjuvant chemotherapy in combination with complete resection of the tumor is necessary for pediatric immature teratomas originating in intra-abdominal undescended testis.

Mature teratoma arising in intraabdominal undescended testis in an infant with previous inguinal exploration: Case report and review of intraabdominal testicular tumors in children

The authors report the youngest case of postoperative intraabdominal mature testicular teratoma in a 5-year-old boy after previous exploration for impalpable testis. A total of 26 cases of intraabdominal testicular tumor in children including our case were reviewed and discussed from both the English- and the Japanese-language literature. The average age was 2.5 years, and, in the 13 children younger than 1 year there were no malignant teratomas, although there was one immature teratoma. Four of these had undergone previous inguinal exploration in which 3 patients except our patient were more than 10 years old. This case report confirms the importance of finding an intraabdominal testis at operation for impalpable testis. Early detection of the testicular location near the internal inguinal ring in these patients supports the hypothesis that the intraabdominal testicular teratoma itself may have been the primary cause of the undescended testis. Furthermore, it is suspected that many of the intraabdominal testicular malignant teratomas in adults may have arisen from these mature testicular teratomas in infants. J Pediatr Surg 37:1236-1238. Copyright 2002, Elsevier Science (USA). All rights reserved.

SURGICAL MANAGEMENT OF THE NONPALPABLE TESTIS: THE CHILDREN'S HOSPITAL OF PHILADELPHIA EXPERIENCE

Purpose The management of the nonpalpable testis permits an individualized operative approach. We analyze the results of surgical management of a large series of patients with a nonpalpable testis. Materials and Methods Between January 1986 and June 1994 we treated 1,866 boys with undescended testes. There were 447 testes (24%) that were not palpable at presentation. Intraoperative data on these patients were collected for age at presentation, bilateral testes position, testicular size, associated inguinal anomalies (vas, epididymis and processus vaginalis) and surgical approach. For intra-abdominal testes postoperative results of 2 surgical techniques, the Fowler-Stephens procedure and Koop orchiopexy (retroperitoneal mobilization of spermatic vessels and vas) were compared in 76 patients with at least 18 months of followup. Results Average patient age at presentation was 34 months with 63% presenting before age 48 months. Of the impalpable testes 58% were on the left side, 35% were on the right side and 7% were bilateral. At operation 181 testes (41%) were atrophic or absent, 91 (20%) were intraabdominal with 14 (3.1%) bilateral, 136 (30%) were in the inguinal canal and 39 (9%) were in other locations, including 22 at the pubic tubercle, 2 in the upper scrotum, 13 in the superficial inguinal pouch and 2 in the perineum. Of the intra-abdominal group associated extratesticular malformations were identified in 36 cases (39%). Attachment of the vas deferens to the testis was abnormal in 23 of 64 cases (36%), including 10 that were completely detached and 13 with head or tail attachment only. Of the 91 evaluable cases in the intra-abdominal group 38 (42%) had been treated with the Fowler-Stephens repair (5 in 2 stages), 33 (36%) with inguinal orchiopexy and intraperitoneal dissection without dividing the spermatic vessels, 5 with 2-stage procedures and vessel preservation and 14 (15%) with orchiectomy. One testis was left in situ. The inguinal approach with intraperitoneal extension was successful in defining the testis location or blind-ending vas and vessels in 100% of the cases. A single operation to perform orchiopexy was successful in 92% of the cases. Overall, results were considered excellent or acceptable in 32 of 33 cases (97%) after Koop orchiopexy and 28 of 38 (74%) after the Fowler-Stephens orchiopexy. Conclusions Nonpalpable testes accounted for 24% of the patients presenting with undescended testes. At surgical exploration 39% of impalpable testes were distal to the external inguinal ring, 41% were atrophic or absent and 20% were intra-abdominal. All cases were treated through a standard inguinal incision. These data provide evidence that the inguinal approach to orchiopexy with transperitoneal mobilization of the vas and vessels without transection is highly successful for the intra-abdominal cryptorchid testis and, to date, is the preferred technique for the management of the intra-abdominal undescended testis.

Cryptorchidism in boys with congenital abdominal wall defects.

Cryptorchidism (CPT) has been suggested to be common in boys with congenital abdominal wall defects (CAWD). It has been hypothesized that the low intra-abdominal pressure in both omphalocele (OMP) and gastroschisis (GS) and brain malformations in patients with OMP contribute to the high incidence of CPT. To determine the incidence of CPT in boys with OMP and GS and to assess the relationship of CPT to the size of the AWD, prematurity, and concomitant anomalies, the hospital records and autopsy reports of 113 boys with CAWD (OMP n = 75; GS n = 38) were reviewed. Twelve (16.0%) boys with OMP had undescended testes; 5 (41.0%) of those had bilateral and 4 (23.5%) intraabdominal undescended testes. The occurrence of CPT in OMP patients did not correlate with the size of the AWD, birth weight, or gestational age. However, congenital cardiac anomalies and cleft lip and palate were significantly more common (P < 0.05) among those with CPT. Two (5.0%) boys with GS, both of whom were born prematurely, had unilateral CPT. In patients with OMP, the incidence of CPT was significantly higher than that of healthy children. There was a correlation between CPT and congenital midline defects such as cardiac anomalies and cleft lip and palate. In patients with GS, the incidence of CPT only slightly exceeded that of normal children and may have been related to prematurity.

Primary congenital bladder diverticula in boys

Three male patients ranging in age at diagnosis from eight to seventeen years were found to have presumed primary congenital bladder diverticula. All 3 patients had a solitary documented urinary tract infection (Staphylococcus 2, Escherichia coli 1), I patient presented with gross hematuria, and in 1 patient the diverticulum was an incidental finding. In all cases, there was no radiologic evidence on voiding cystourethrography of physiologic or anatomic ureteral or bladder outlet obstruction. In a nine-year-old boy there was ipsilateral renal agenesis, an intra-abdominal undescended testis, and an atretic ureter arising from the diverticulum. The older boy had Ehlers-Danlos syndrome. If the diverticulum is enlarging, compromises the ureterovesical valve mechanism, or by virtue of incomplete bladder emptying is believed to promote urinary tract infection, it should be removed. A surgically conservative course is followed in the Ehlers-Danlos syndrome because of the bleeding tendency and tissue abnormalities.

Epididymal Anomalies Associated with Hydrocele/Hernia and Cryptorchidism: Implications Regarding Testicular Descent

Controversy exists regarding the role of the epididymis in testicular descent, as epididymal abnormalities have been reported in 36 to 79% of boys with an undescended testis. Although most undescended testes are associated with a patent processus vaginalis, the incidence of epididymal abnormalities in descended testes with a patent processus has not been reported. Epididymal morphology was examined in 81 boys with a hydrocele/hernia without cryptorchidism (90 testes) and 100 children undergoing orchiopexy (115 testes). Boys with an intra-abdominal undescended testis were excluded. Among 48 boys with a hydrocele/hernia 24 (50%) had an epididymal abnormality if the processus was patent and communicated with the testis (complete hernia), compared to 4 of 42 patients (10%) if there was not a communication with the testis (p <0.01). Among the 96 children with an undescended testis 68 (71%) had an epididymal abnormality if there was a patent processus, compared to 3 of 19 boys (16%) without a patent processus (p <0.01). These data suggest that most epididymal abnormalities probably do not contribute to testicular maldescent.

The Undescended Testis: Management after Puberty

The patient seen after puberty with an intra-abdominal unilateral undescended testis should have orchiectomy. The patient seen after puberty and before the age of 50 years with unilateral undescended testis in the inguinal region should have orchiectomy because the risk of death from malignancy exceeds the risk of anesthesia and orchiectomy.