Left Undescended Testis Research Articles

Gubernaculum with a long loop vas deferens

Abstract Cryptorchidism by definition suggests a hidden testis: a testis that is not within the scrotum and does not descend spontaneously into the scrotum by six months of age. Cryptorchid testes may be absent or undescended. If they haven't descended by six months of age, they are unlikely to descend and generally require surgical manipulation into and attachment to the scrotum to avoid potential complications and sequelaes. This case describes an anatomical variation of vas deferens with gubernaculum which not previously reported in literature. A 9 month old boy was presented with diagnosis of left undescended testis and underwent standard orchiopexy operation. At the time of gubernacular dissection a long loop vas deferens without epididymis abnormalities was observed. A long loop of vas deferens originated from tail of epididymis and rotated up then formed a long loop with in the gubernaculum. This case reminds us of the possibility of anatomical variations and the importance of keeping them in mind to prevent complications at time of surgery.

Transverse testicular ectopia: What surgeons must know; Insights in embryology and management

Transverse testicular ectopia (TTE) is a rare congenital anomaly, in which both gonads migrate toward the same hemiscrotum. It is usually associated with other abnormalities such as persistent Mullerian duct syndrome (PMDS), true hermaphroditism, inguinal hernia, hypospadias, pseudo-hermaphroditism, and scrotal anomalies. Most of the reported cases are in children with very few reported cases in adults. We report a case of 30-year-male, who presented with right reducible inguinal hernia and left undescended testis. Diagnosis was confirmed preoperatively by ultrasound followed by diagnostic laparoscopy and open inguinal exploration for orchiopexy. Bilateral transseptal orchiopexy and hernioplasty were performed. He had an uneventful recovery. Due to lack of awareness most of these cases are diagnosed accidentally intraoperatively. Preoperative diagnosis can be achieved by proper knowledge and imaging techniques (ultrasonography and magnetic resonance imaging). Surgeons who frequently repair inguinal hernias should be aware of disease and appropriate surgical management options available to them when this condition is unexpectedly identified during inguinal exploration. The embryology, clinical features and management algorithm are discussed herewith with review of pertinent literature.

Ectopic expression of Sonic Hedgehog in a cryptorchid man with azoospermia: A case report

A 30-year-old man presented with a left undescended testis, right testicular deficiency and azoospermia. Testicular biopsy revealed an absence of spermatocytes and increased numbers of Leydig cells in the undescended testis. Additional comparative analyses were undertaken to explore Sonic Hedgehog (Shh) immunostaining in the testis of juvenile and adult mice, in the testis of the patient with cryptorchidism, and in archival testicular tissue from a patient with obstructive azoospermia and a patient with prostate cancer. Shh immunostaining was demonstrated in spermatocytes in juvenile and adult mouse testis and in the patients with obstructive azoospermia and prostate cancer, suggesting that Shh signalling is involved in normal spermatogenesis. In the patient with cryptorchidism, Shh immunostaining was localized to the Leydig cells, which suggests that Shh might be involved in the abnormal expansion of the Leydig cell population in the testis. These preliminary data on the appearance of Shh protein during normal spermatogenesis might provide the basis for further investigations to clarify the role of Shh signalling in spermatogenesis during normal and pathogenic testis development.

A rare case of continuous type splenogonadal fusion in a young male with primary infertility.

Splenogonadal fusion is a rare developmental anomaly in which an abnormal connection between splenic tissue and gonads or mesonephric derivatives is present. Here we present a case of young man with the complaint of primary infertility for 3 years. On evaluation (USG and MRI abdomen and pelvis), his right scrotal testis was atrophied and left intra-abdominal undescended testis. On laparoscopic assessment, a mass was seen on the left side due to continuous type of splenogonadal fusion for which excision and left orchidectomy were done. Postoperative period was uneventful and he was discharged under satisfactory condition. Splenogonadal fusion is a rare entity and it is commonly mistaken for testicular tumour. It should be considered in the differential diagnosis of testicular masses especially when there are associated congenital anomalies and preoperative laparoscopic assessment, should be done to avoid unnecessary radical surgery.

Extrarenal testicular Wilms’ tumor in a 3-year-old child

We report an extremely rare case of extrarenal testicular Wilms' tumor in a 3-year-old boy with intrabdominal undescended left testis. The patient was admitted because of pain and vomiting, with evidence of a huge abdominal mass. At surgery a large tumor arising from the intrabdominal testis was found. Histology showed the classical triphasic Wilms' tumor elements: epithelial, mesenchymal and blastemal areas. Extrarenal Wilms' tumors account for only 3% of all Wilms' tumors and just -100 cases have been reported in literature. Testicular origin is anecdotic. We present histomorphological, histogenetic, clinical, diagnostic, prognostic and therapeutic features of this rare tumor.

Congenital anomalies of kidney and hand: a review.

‘Acro-renal syndrome’ refers to co-occurrence of congenital renal and limb anomalies. The term acro-renal syndrome was coined by Curran et al. in 1972 though Dieker and Opitz were the first to report this phenomenon in three male patients in 1969. The common limb defects include oligodactyly, ectrodactyly, syndactyly or brachydactyly anomalies of the carpal and tarsal bones and the common renal anomalies observed are unilateral renal agenesis (URA), bilateral renal hypoplasia, ureteric hypoplasia, hydroureteronephrosis and duplication abnormalities. The acro-renal syndrome as originally described is rare, reported only in ∼20 patients in the international literature. We report a 23-year-old male patient with renal anomalies in the form of absent right kidney, left-sided vesicoureteric reflux (VUR) and skeletal anomalies viz short radius, absent first metacarpal ray in left hand and left undescended testis, consistent with Dieker's type acro-renal syndrome. Apart from the classical acro-renal syndrome, several anomalies of acro-renal patterns and the abnormal gene loci involved are described in the literature. This article is a comprehensive review of the development of kidneys, types of acro-renal syndromes, congenital anomalies of the kidney and urinary tract (CAKUT), syndromes associated with combined limb and renal anomalies, and anomalies associated with URA.

Persistent Müllerian Duct Syndrome: a Case Report

Persistent Müllerian duct syndrome is a rare form of internal male pseudohermaphroditism caused by defects in synthesis or action of Müllerian-inhibiting factor, due to which Müllerian duct derivatives, such as uterus, fallopian tube, and upper vagina, are normally present in 46XY males. Here, we report a 26-year-old male with right-sided obstructed inguinal hernia with left undescended testis. On exploration, hernial sac containing bowel loops, uterus with fallopian tubes, upper vagina, and testes were present.

CHARGE Association

We present here a case of 17-year-old boy from Kolkata presenting with obesity, bilateral gynecomastia, mental retardation, and hypogonadotrophic hypogonadism. The patient weighed 70 kg and was of 153 cm height. Facial asymmetry (unilateral facial palsy), gynecomastia, decreased pubic and axillary hair, small penis, decreased right testicular volume, non-palpable left testis, and right-sided congenital inguinal hernia was present. The patient also had disc coloboma, convergent squint, microcornea, microphthalmia, pseudohypertelorism, low set ears, short neck, and choanalatresia. He had h/o VSD repaired with patch. Laboratory examination revealed haemoglobin 9.9 mg/dl, urea 24 mg/dl, creatinine 0.68 mg/dl. IGF1 77.80 ng/ml (decreased for age), GH <0.05 ng/ml, testosterone 0.25 ng/ml, FSH-0.95 μIU/ml, LH 0.60 ΅IU/ml. ACTH, 8:00 A.M cortisol, FT3, FT4, TSH, estradiol, DHEA-S, lipid profile, and LFT was within normal limits. Prolactin was elevated at 38.50 ng/ml. The patient's karyotype was 46XY. Echocardiography revealed ventricularseptal defect closed with patch, grade 1 aortic regurgitation, and ejection fraction 67%. Ultrasound testis showed small right testis within scrotal sac and undescended left testis within left inguinal canal. CT scan paranasal sinuses revealed choanalatresia and deviation of nasal septum to the right. Sonomammography revealed bilateral proliferation of fibroglandular elements predominantly in subareoalar region of breasts. MRI of brain and pituitary region revealed markedly atrophic pituitary gland parenchyma with preserved infundibulum and hypothalamus and widened suprasellar cistern. The CHARGE association is an increasingly recognized non-random pattern of congenital anomalies comprising of coloboma, heart defect, choanal atresia, retarded growth and development, genital hypoplasia, ear abnormalities, and/or deafness.[1] These anomalies have a higher probability of occurring together. In this report, we have described a boy with CHARGE association.

A Case Presentation With Tranverse Testicular Ectopia

Ectopic testis is defined as the aberrant location of testis in places other than the scrotum during descent from the inguinal canal after the external ring. These aberrant locations include suprapubic site, medial of the thigh, perineum, anterior abdominal wall and contralateral scrotum. An interesting and rare form of ectopic testis is transverse testicular ectopia (TTE) or in other words, cross testicular ectopia. This abnormality presents with both testicles in the same hemiscrotum. In this manuscript, we present a four-year old male case who presented to our out patients clinic with left undescended testis and was diagnosed with transverse testicular ectopia. doi:10.4021/ijcp2w

Complete urogenital nonunion

A 7.5-year-old boy was admitted to our department with left undescended testis. On surgical exploration, the vas deferens and epididymis were normal in appearance in its route to the scrotum, but no obvious testis or testis-like structure was identified. Exploration was extended to the abdominal cavity via the processus vaginalis, and the testis was found near the sigmoid colon without any connection to the vas deferens and epididymis. The testis was freed from surrounding structures preserving the testicular vasculature, and an orchidopexy was performed. In cases of nonpalpable testis with the vas deferens and epididymis reaching to the scrotum, an intra-abdominal testis owing to a nonunion phenomenon must be considered, and extended exploration should be performed.

Abdominal wall ectopic testis mimicking spigelian hernia

We encountered a patient with a swelling in the left lateral infraumbilical region and a left undescended testis. The appearance of the swelling was suggestive of a spigelian hernia. At operation, the swelling was actually an abdominal ectopic testis with associated inguinal hernia. This unusual finding led us to report this occurrence and present a brief review of the relevant literature.

Torsion of Undescended Testis in a 14-Month-Old Child Refusing to Bear Weight

In this report, we discuss a case of a 14-month-old male presenting in the emergency department with refusal to bear weight on his left leg. Plain radiographic studies revealed no evidence of effusion, fracture, or dislocation. Laboratory studies were significant for an elevated white blood cell count, erythrocyte sedimentation rate, and C-reactive protein. Further studies included unremarkable ultrasound of the left hip and normal magnetic resonance imaging (MRI) of both hips. An incidental finding on MRI was a left inguinal mass concerning an incarcerated hernia. Ultrasound of this mass demonstrated a left undescended testis within the inguinal canal and possible incarcerated paratesticular inguinal hernia. The final pathologic diagnosis of a torsed gangrenous left testicle within the inguinal canal was confirmed during surgery.

Mixed gonadal dysgenesis: whole life follow-up of a rare case

There are two forms of gonadal dysgenesis - mixed and pure. In the mixed form, some differentiated gonads as well as some either ovarian or testicular rudiments are present. This form results in a number of phenotypes with a possibility of malignant transformation. In the pure form occurring in female gender, also some rudimental gonads are bilaterally present. In the case of simultaneous presence of Y chromosome, also some malignant transformation may appear (Siklar et al. 2007). Chromosomal aberrations are present in 2-7 % adult pairs with fertility disorders and in 0.6 % of newborns. However, only few cases with similar chromosomal aberrations were described so far (Roubin et al. 1977; Alexander et al. 1978; Teyssier et al. 1982; Caglayan et al. 2009). Mixed gonadal dysgenesis presents as a unilateral testis, usually intraabdominal, also with a streak gonad on contralateral side, and persistent mullerian structures. 45X/45XY karyotype is the most frequent in such cases with predominance of 45X cells in both peripheral lymphocytes and gonads. We present a rare case of a left undescended testis, normally descended right testis, with penoscrotal hypospadias, who had a normal karyotype and whose histopathological findings were endometrial tissue and fallopian tube in left testicular biopsy. Gonadal dysgenesis should always be kept in mind because of a possibility of undescended testis and proximal hypospadias. If karyotype reveals a 46XY gonadal dysgenesis, these patients need the careful follow-up to screen for gonadoblastoma in remaining normal testis. Subjecting the patients to prophylactic orchidectomy with hormone replacement can be an additional option in such patients.

Transverse testicular ectopia with persisting mullerian remnant masquerading as right inguinal hernia and left undescended testis

Transverse testicular ectopia with persisting mullerian remnant masquerading as right inguinal hernia and left undescended testis

Torsion of Testis in an Infant with Unilateral UDT

Torsion of an undescended testis is uncommon. Torsion of a cryptorchid testicle presents a nonspecific symptomatology. Clinical suspicion indicates emergent surgical exploration, irrespective of Doppler ultrasound with its inherent false negative results. Management of the contralateral testis is controversial. We emphasize the need of a complete physical examination of the child who goes to the emergency room with nonspecific symptoms of abdominal pain and ipsilateral empty hemiscrotum to rule out torsion of a cryptorchid testicle. Herein, we report a one-year-old infant with missed torsion of undescended left testis.

Mixed gonadal dysgenesis with normal karyotype : A rare case report

Mixed gonadal dysgenesis (MGD) presents as a unilateral testis, usually intraabdominal, a streak gonad on contralateral side, and persistent mullerian structures. 45X/45XY karyotype is most frequent in such cases with predominance of 45X cells in both peripheral lymphocytes and gonads. We present a rare case of a left undescended testis, normally descended right testis, with penoscrotal hypospadias, who had a normal karyotype and whose histopathological findings were endometrial tissue and fallopian tube in left testicular biopsy. Gonadal dysgenesis should always be kept a possibility in patient with undescended testis and proximal hypospadias. If karyotype reveals a 46XY gonadal dysgenesis, these patients need all the more careful follow-up to screen for gonadoblastoma in remaining normal testis. Subjecting the patients to prophylactic orchidectomy with hormone replacement can be an additional option in such patients.

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.

Inflammatory myofibroblastic tumor larynx mimicking laryngeal papillomatosis

Inflammatory myofibroblastic tumor (IMT) is an uncommon condition and only a few cases of IMT in the spermatic cord have been reported, with none associated with an undescended testis. We present the case of a man with an undescended left testis who had an IMT involving the spermatic cord. He was treated with surgery and no adjuvant therapy afterward. He was disease free at 2.5 years of follow-up. A brief discussion of the pathologic features and management of the condition is also provided.

Inflammatory Myofibroblastic Tumor of Spermatic Cord in Undescended Testis

Inflammatory myofibroblastic tumor (IMT) is an uncommon condition and only a few cases of IMT in the spermatic cord have been reported, with none associated with an undescended testis. We present the case of a man with an undescended left testis who had an IMT involving the spermatic cord. He was treated with surgery and no adjuvant therapy afterward. He was disease free at 2.5 years of follow-up. A brief discussion of the pathologic features and management of the condition is also provided.

Seminoma in a Male Phenotype 46XX True Hermaphrodite

Although true hermaphrodite is uncommon, it has been reported in more than 400 individuals. Tumours arising in the gonads of true hermaphrodite is a very rare finding and only very few cases have been reported in the literature. We report a case of a 35-year-old phenotype man with bilateral undescended testis with lump hypogastrium. On examination, he had an ovotestis on one side and pure seminoma arising in testis on the other side. The seminoma arising in the left undescended testis was successfully treated by excision and combination chemotherapy. Cytogenetic studies revealed that 46XX karyotype with primer specific for the sex-determining region of the Y chromosome was negative. The karyotypic abnormality noticed in the patient is also reviewed in the article.