Transverse Testicular Ectopia Research Articles

Familial cross-testicular ectopia: a clinical case report

Cross or transverse testicular ectopia is a rare congenital condition of the reproductive system that involves the migration of a testicle into the opposite inguinal canal, along with the presence of an inguinal hernia on the same side as the ectopic testicle. In the modern literature, there are discussions about diagnostic issues, particularly the use of ultrasound scanning and magnetic resonance imaging to diagnose this condition. However, it is the results of laparoscopic examination that determine the most accurate criteria for surgical treatment. Many publications discuss the choice of surgical tactics, including separate transabdominal orchiopexy, with or without laparoscopic assistance; transeptal orchiopexy on both sides of the scrotum; and rare cases of orchiopexy for both testicles on one side of the scrotum. Ultimately, the choice of surgery depends on the individual characteristics and needs of the patient, and the surgeon should make the decision based on these factors. The article describes, for the first time, a case of familial testicular ectopia with bilateral inguinal hernia in siblings who underwent surgery using laparoscopic assistance. The method used was single-trocar laparoscopic access with transscrotal transeptal orchiopexy and simultaneous bilateral puncture of the inguinal ring and suture. During the long-term follow-up period (50 and 20 months after surgery) in both siblings, there were no signs of malformation or atrophy of the gonads.

Discovery of a Case of Left Transverse Testicular Ectopia during a General Surgery Campaigna Diagala

We report the observation of a 9-month-old male child who consulted us for a left inguino-scrotal swelling, and the right testicle was not palpable. The operative exploration found a large hernial sac, the opening of which revealed two testicles of normal size and appearance with partial epididymo-testicular independence. We performed in-dartos orchidopexy on both sides intraoperatively. The patient was seen again at the age of 24 months, with both testicles in place and of normal size and consistency. A follow-up abdominal ultrasound was performed which was unremarkable.

'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.

Unilateral transverse testicular ectopia with recurrence of inguinal hernia: a case report

BackgroundCrossed testicular ectopia or transverse testicular ectopia is an extremely rare urogenital anomaly. In this condition, on average at 4 years of age the testes migrate through the inguinal canal and one or both testes may turn up in the abdomen, inguinal region, or in the hemiscrotum, with an empty contralateral hemiscrotum. Our case report documents transverse testicular ectopia in a 5-year-old boy who presented with right inguinal hernia and nonpalpable left testis. He underwent previous right herniorrhaphy at the age of 1 year.Case presentationA 5-year-old Iranian boy was diagnosed with a right inguinal hernia. He underwent right inguinal herniorrhaphy at the age of 1 year. For this case report, the hernia symptoms had returned. Both testicles were palpated in the right scrotum, an ultrasound examination also revealed both testicles to be present in the right scrotum, and a hernia sac located in the right inguinal region with an internal ring. The patient was recommended to undergo a surgical reconstruction. Surgical reconstruction was performed by crossing the left testis in the transseptal orchiopexy technique.ConclusionIn patients with cryptorchidism on one side and an inguinal hernia on the other side, the surgeon must consider a rare condition known as transverse testicular ectopia. Sonography can be helpful for diagnosing cases where transverse testicular ectopia is suspected, evaluating other anomalies, and selecting the most appropriate treatment.

Transverse testicular ectopia associated with inguinal hernia: Case report

Transverse testicular ectopia associated with inguinal hernia: Case report

Coexistence of Transverse Testicular Ectopia and Coarctation of Aorta: A New Entity or Just a Co-incidence?

Coexistence of Transverse Testicular Ectopia and Coarctation of Aorta: A New Entity or Just a Co-incidence?

TRANSVERSE TESTICULAR ECTOPIA WITH INCIDENTAL TESTICULAR TUMOR, DISCOVERED UPON SYMPTOMATIC TESTICULAR TORSION

Transverse testicular ectopia is a condition in which a testicle crosses the midline and descends through the contralateral inguinal canal, with both testes in the same scrotal compartment. It is reported to be present in about 2% of persons who present with non-palpable testicles. Most transverse testicular ectopia patients undergo orchiopexy in early childhood; however, in rare cases, they are diagnosed in adulthood upon detection of testicular tumors.A 40-year-old man visited our hospital complaining of right abdominal pain. His right testis was palpable in the right scrotum; however, the left scrotal compartment seemed empty and there was a painful mass on the upper part of the right scrotal compartment. Computed tomography showed that both spermatic cords traversed through the right inguinal canal, and transverse testicular ectopia was diagnosed. Ultrasonography showed absent left testicular circulation on the upper part of the right scrotum. Upon diagnosis of left testicular torsion, emergency surgery was conducted. In the right scrotum, there was a normal right testicle, and a necrotic left testicle which was twisted 180 degrees on its axis, towards the cranial side. Histopathology of the excised left testicle revealed an incidental seminoma, pT1. Tumor markers following surgery were negative, and there was no evidence of recurrence observed with two years and five months of follow-up.Non-palpable testicular torsion may also be a transverse testicular ectopia. Therefore, it is necessary to consider malignant tumors based on the patient's age.

Diagnostic value of ultrasound in children with transverse testicular ectopia.

ObjectiveThe study aimed to investigate the diagnostic value of ultrasound in children’s transverse testicular ectopia (TTE).Materials and methodsWe retrospectively studies all TTE cases diagnosed in our hospital from January 2017 to December 2021. All cases were evaluated by ultrasound examination and compared to physical examination and diagnostic laparoscopy results.ResultsThis study included 14 TTE patients in total, with a median age was 1.08 years. In the 14 TTE, physical examination found 10 TTE cases, of which nine testes were located in the opposite scrotum, one testis was located in the opposite groin, and the other four testes were not observed by physical examination. All cases were diagnosed by preoperative ultrasound, and nine testes were located in the opposite scrotum, two testes were located in the opposite groin, and three testes were located next to the opposite iliac vessel in the abdominal cavity. Preoperative ultrasound showed the ectopic spermatic cord in six cases (6/14, 42.8%) and persistent Müllerian duct syndrome (PMDS) in one case (1/14, 7%). Diagnostic laparoscopy finally confirmed 14 cases of TTE, which was consistent with preoperative ultrasound, and the coincidence rate was 100% (14/14). Among the 14 cases of TTE, diagnostic laparoscopy showed that 12 cases had ectopic spermatic vessels and vas deferens (12/14, 85.7%), and six cases were associated with PMDS (6/14, 42.8%). When TTE was associated with the ectopic spermatic cord and PMDS, the diagnostic performance of diagnostic laparoscopy was better than that of preoperative ultrasound (P < 0.05). The testis volume of the affected side of TTE was less than that of the contralateral testis (P < 0.05).ConclusionUltrasonography is very helpful for the preoperative diagnosis of TTE in children, and it is suitable as a non-surgical method for locating ectopictestis. Preoperative assessment of the exact presence of PMDS is difficult and unclear. This may be related to factors such as pelvic developmental stages in infancy, examination techniques, and atypical imaging findings of PMDS.

Lessons learned from five patients of persistent Mullerian duct syndrome: A case series.

IntroductionPersistent Mullerian duct syndrome (PMDS) is a genetic disorder characterized by the persistence of Mullerian structures of fallopian tubes, uterus, and upper two-thirds of the vagina in a normal XY male. It is a rare genetic disorder that has been reported less than two hundred times. More rarely it may be seen in association with transverse testicular ectopia (TTE).Presentation of casesFour patients presented with swelling in the inguinal region and undescended testes. Pre-op ultrasound was done on three of these patients and it showed a hernia with testes inside the hernial sac. Hernia surgery was planned for these patients. One patient presented with a complaint of bilateral cryptorchidism that prompted laparoscopic exploration. In all five patients, on surgical exploration, Mullerian derivatives i.e., fallopian tubes, uterus, and vagina were found in the abdomen. Hernia surgery was done and Mullerian structures were excised. For undescended testes, patients had orchiopexy or orchidectomy depending on their respective age group.DiscussionPMDS is caused by failure of production of Mullerian inhibiting substance. Mullerian structures other than causing inguinal hernia are also at risk of malignant transformation, which is the most important significance of this condition. In light of the risk of malignant transformation, Mullerian structures must be excised.ConclusionTo prevent the risk of malignant transformation in PMDS, the Mullerian structures must be excised. If PMDS is associated with TTE, orchiopexy must be done for pediatric patients and orchidectomy for adult patients.

Persistent Mullerian Duct Syndrome with Transverse Testicular Ectopia Presenting as an Irreducible Inguinal Hernia

Persistent Mullerian Duct Syndrome with Transverse Testicular Ectopia Presenting as an Irreducible Inguinal Hernia

A Case of Adult Inguinal Hernia with Left Transverse Testicular Ectopia

A Case of Adult Inguinal Hernia with Left Transverse Testicular Ectopia

Transverse Testicular Ectopia: A Rare Case Report

Transverse testicular ectopia (TTE) is a rare but well-known congenital anomaly that occurs 1 in 4 million in which both testes migrate toward the same hemiscrotum. In most of the cases it is an intra-operative finding, but preoperative diagnosis can be made by careful history taking, physical examination and imaging studies. Further evaluation is very important because it can be associated with other congenital anomalies. We report a case of TTE in a 32 years old male who presented with sudden painful swelling in right inguinoscrotal region. Physical examination revealed right sided obstructed inguinal hernia and left sided non palpable testis with underdevelopment of left hemiscrotum. On exploration, one testis is found within the hernial sac and the other testis within scrotum of same side. The testis which was already in right side of scrotum was kept in same place and the other testis which was found within hernial sac was kept in subdartos pouch at the root of right side of scrotum. Faridpur Med. Coll. J. 2021;16(1):52-54

A rare form of persistent Mullerian duct syndrome: Transverse testicular ectopia with germ cell testis cancer and hernia uteri inguinalis

Persistent Mullerian duct syndrome is a rare form disorder of sexual differentiation characterised by the persistence of Mullerian derivatives (fallopian tubes, uterus and the proximal vagina) in males with an XY karyotype and normal virilisation. We report a case of a 29-year-old man with right transverse testicular ectopia, mix germ cell cancer at ectopic right testis and left-sided obstructed inguinal hernia containing a uterus and fallopian tube. We performed orchiectomy and hysterectomy on the patient.

A curious case of toddler with hernia and much more

Transverse testicular ectopia (TTE) with fused vas deferens is an extremely rare clinical entity. Herein, we presented a case of a 2 years old patient with left inguino-scrotal swelling associated with pain lasting for 3 days. Clinical examination revealed an empty right hemi-scrotum, a left-sided giant inguino-scrotal swelling. Laboratory tests were normal. Ultrasound imaging (US) of the scrotum demonstrated the presence of both testes in the same left hemi-scrotum with inguinal hernia and enterocele as content. Surgical intervention in suspicion of obstruction was carried out through inguinal incision. There was a congenital inguinal hernia with appendix (type 1-Amyand’s hernia) and cecum as content with two well developed testes on the same side with separate epididymis and vas deferens. Both the testes were united by a mesorchium. Hence, reduction of contents with herniotomy and both the testes were anchored to inner aspect of left thigh one above the other. We reviewed the literature for rare diagnosis of TTE.

Crossed Testicular Ectopia: Case Report

Crossed testicular ectopia or transverse testicular ectopia (TTE) is one of the rare congenital anomaly upon the genitourinary system. It happens when one of the hemiscrotum is empty and the other side contains two testes. Hernia association, worried parents about the undescended testis and incidental imaging are the classic scenarios of presentation. However, multiple reported cases are diagnosed during the surgery as incidental finding. Accordingly, bilateral orchidopexy is warranted.

Abstract #1015220: Rare Case of a Young Male with Persistent Mullerian Duct Syndrome

Persistent mullerian duct syndrome (PMDS) affects the development of sexual organ in male. This condition is inherited in an autosomal recessive pattern. Male with PMDS have normal testes and normal external genitalia. However they also have uterus and fallopian tubes. PMDS can present in one of three ways: bilateral cryptorchidism, unilateral cryptorchidism with contralateral hernia and transverse testicular ectopia.

Clinical Characteristics, Ultrasonographic Findings, and Treatment of Pediatric Transverse Testicular Ectopia: A 10-Year Retrospective Review

To evaluate the clinical data, ultrasonic features, treatment, and long-term outcome of transverse testicular ectopia (TTE) in children. Children with TTE were enrolled in the study between November 2009 and August 2019 in Shenzhen Children's Hospital in China. Clinical information, including demographiccharacteristics, clinical manifestations, TTE-associated anomalies, ultrasonographic findings, and surgical procedures, were collected from all patients. Patients were re-evaluated at the end of 4 weeks and 6 months after the operation. A total of 16 cases were enrolled and underwent surgeries, all patients had undescended testis with contralateral inguinal hernia. The ultrasonic findings showed two testicles in 15 cases and no testes in 1 case. Müllerian ducts remnants were found by laparoscopy in 6 cases or by ultrasound in one case. Sixteen cases were treated with laparoscopy orchidopexy or laparoscopy assisted trans-septal orchidopexy-inguinal exploration. After surgery, 16 patients had both testicles in an orthotopic position and with equal size, with normal blood flow. TTE should be suspected in patients with nonpalpable undescended testis and contralateral inguinal hernia. The contralateral processus vaginalis sac occurs in all cases of TTE. Ultrasonography is essential for an early diagnosis of TTE. Laparoscopy-assisted surgery is safe, effective, and minimally invasive therapy for TTE.

Transverse Testicular Ectopia in a Context of Persistence of the Peritoneo-vaginal Duct: A Case Report

True testicular ectopic represent 1% of testicular migration abnormalities. Transverse or crossed form is a very rare form of testicular ectopia. It is defined as an abnormal localization of both testicles in the same hemi-scrotum. Association of a persistence of vaginal process or a syndrome of persistence of the Müllerian canal is more commonand deserves to be underlined. The diagnosis is often intraoperative but can be facilitated by an ultrasound performed preoperatively. Before any case of testicular ectopy, notably an empty scrotum associated with an inguinal hernia, transverse testicular ectopy should be suspected. Orchiopexy in-dartos on both sides after a trans septal lowering of the testicle concerned is the rule. Currently with the development of laparoscopy, management can be performed by open surgery but also depending on the availability of the technical platform and the experience of the surgeon, laparoscopic treatment is possible. Transverse testicular ectopy is a rare form of testicular ectopy. the principle of the treatment consists in the lowering of the testicle in intra scrotum and the orchidopexy. Long-term follow-up of testicules should be systematic because risks of infertility and malignant degeneration exist and are multiplied respectively by six and eight compared to the rest of the population. We report a case, diagnosed in a secondary health center, and review the literature.

Transverse testicular ectopia with fused vas deferens

Transverse testicular ectopia (TTE) is a rare congenital anomaly where both testicles are migrated in the same hemiscrotum or inguinal canal. The etiology is unknown and it has three types. Embryologically, several theories regarding the origin of TTE have been suggested including adhesion and fusion of developing Wolffian canals, aberrant gubernaculum, testicular adhesions, defective formation of the internal inguinal ring, and traction on the testis by persistent Mullerian structures. To date, more than 100 cases of TTE have been reported in the literatures. TTE with fused vas deferens is extremely rare. We present a case of 3 years old child referred for admission in our teaching hospital with right side inguinal hernia and left side undescended testis. After diagnosis with physical exam and ultrasonography, TTE was diagnosed and the child underwent inguinal herniotomy, ipsilateral orchiopexy and contralateral transseptal orchiopexy. The association of TTE with fused vas deferens is rare and transseptal orchiopexy is the procedure of choice for definite treatment.

Genetic and histopathological analysis of transverse testicular ectopia without persistent M\xfcllerian duct syndrome: two case reports

BackgroundTransverse testicular ectopia (TTE) is a rare anomaly in which both testes descend through a single inguinal canal into the same hemiscrotum. Although almost 20–50% of patients with TTE exhibit persistent Müllerian duct syndrome (PMDS) and many genetic analyses have been performed, no reports have described the genes contributing to TTE without PMDS. Here, we report two cases of TTE without PMDS using immunohistochemical staining and genetic analysis.Case presentationTwo Asian patients with TTE without PMDS were subjected to orchiopexy. We performed testicular biopsies during operation and obtained blood samples before the operation. Testicular tissues were stained for c-kit, placental alkaline phosphatase (PLAP), and undifferentiated embryonic cell transcription factor 1 (UTF1) to evaluate the presence of intratubular malignant germ cells. Additionally, we performed polymerase chain reaction-based direct sequencing to identify single nucleotide polymorphisms in genes associated with regression of the Müllerian duct and testicular descent (that is, anti-Müllerian hormone [AMH], AMH receptor 2 [AMHR2], insulin-like 3 [INSL3], and relaxin family peptide receptor 2 [RXFP2]). The three-dimensional structures of proteins were predicted using SWISS-MODEL. In immunohistochemical analysis, c-kit and UTF1 were positive, whereas PLAP was negative in three testicular tissue samples from the two patients. These features were also detected on the unaffected side. In variant analysis, common missense variants in the AMH gene (g.365G>T; c.165G>T; p.Ser49Ile [rs10407022]) were observed. All variants in INSL3 and RXFP2 genes were intronic or silent.ConclusionsBecause UTF1, a specific marker of spermatogonial stem cell activity, was expressed in both the affected and unaffected sides in the testicular tissues of two patients, the risk of malignancy may be high in these patients. Although the etiology of TTE without PMDS remains unclear, our variant analysis results were consistent with previous reports, and variants in the AMH gene (rs10407022) may contribute to the specific phenotype of TTE without PMDS.