British Journal of Radiology 75 (2002),635-636 © 2002 The British Institute of Radiology
A scrotal lump
J Makowska-Webb and
D K Asamoah
Department of Radiology, Warrington Hospital NHS Trust, Lovely Lane, Warrington WA5 1QG, UK
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Introduction
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A 41-year-old man presented with a long history of a right scrotal lump. At presentation it had been present for at least 25 years and was otherwise asymptomatic. He had sought medical opinion in the past and was told that this mass was probably a "sweat gland cyst" and of no significance. Recently, however, it had increased in size, although remaining painless. Ultrasound examination of the scrotum was performed (Figure 1
). What is the diagnosis?
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Figure 1. Transverse ultrasound scan showing normal right testis (3.7 cm in long axis) and an adjacent mass, 1.8 cm in size, at the site of the palpable right anterior scrotal mass. The left testis and epididymis were normal.
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Answer
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The mass shown on ultrasound at the site of the palpable right anterior scrotal mass has identical echotexture to the normal testis, apart from scattered punctate areas of increased echogenicity within it, which are likely to represent either microcodcifications or areas of fibrosis. The palpable right scrotal lump was owing to a supranumerary testis.
Polyorchidism, defined as presence of more than two testes, is a rare developmental anomaly of the genital tract, with approximately 70 cases reported [1]. The most popular, although unproven, theory explains its origin as being due to either duplication or abnormal division of the urogenital ridge [2]. Polyorchidism is said to be more common on the left. A minority (10%) of supranumerary testes have their own epididymis. Associations with cryptorchidism, indirect inguinal hernias, testicular torsion, hydrocoele, epididymitis, varicocoele and infertility have been reported, but were all absent in our patient [1, 3].
The management of polyorchidism is not well established. Since there is concern about development of malignancy within the supranumerary testis, especially in cases associated with cryptorchidism, surgical exploration with biopsy is recommended by some clinicians. However, many argue that this is unnecessary in the absence of any concomitant disorder or suspicious ultrasonographic features [4]. Some clinicians perform MRI for reassurance [1, 3].
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Acknowledgments
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We would like to thank Dr C Yeong, Consultant Radiologist, for his help in preparing the illustrations.
Received for publication December 18, 2000.
Accepted for publication February 16, 2001.
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References
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- Mastroeni F, D'Amico A, Barbi E, Ficcara V, Novella G, Pianon R. Polyorchidism: 2 case reports. Arch Ital Urol Androl 1997;69:319–22.[Medline]
- Wolf B, Youngson GG. Polyorchidism. Pediatr Surg Int 1998;13:65–6.[Medline]
- Thum G. Polyorchidism case report and review of literature. J Urol 1991;145:370–2.[Medline]
- Ghiacy S. Ultrasound diagnosis of polyorchidism. Br J Radiol 1996;69:78.[Abstract]
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