Splenogonadal fusion
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At the time the article was created Matt A. Morgan had no recorded disclosures.
View Matt A. Morgan's current disclosuresAt the time the article was last revised Yaïr Glick had no financial relationships to ineligible companies to disclose.
View Yaïr Glick's current disclosuresSplenogonadal fusion is a rare anomaly that occurs when there is congenital fusion between a portion of the spleen and a gonad or other mesonephric derivative.
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Epidemiology
Much more common in male patients (~95%), occurs most commonly on the left (98%) and usually involves the testis (95%). Has been found in patients from birth to 81 years old 3.
Clinical presentation
Most often an incidental finding but may present as a left-sided testicular mass or may present as cryptorchidism. The continuous type (see Pathology below) may be associated with other congenital anomalies, such as limb deformities or micrognathia.
Pathology
The fusion of the two tissue types is assumed to occur between the 4th-10th week of gestation.
There are two main types:
continuous: gonad linked to spleen by a trans- or retroperitoneal cord of splenic tissue or fibrous cord with nodules of splenic tissue; often associated with other congenital anomalies
discontinuous: ectopic rests of splenic tissue are present in the gonad
Splenogonadal fusion with the ductus deferens or spermatic cord is exceedingly rare.
Radiographic features
Ultrasound
the discontinuous form appears as a homogeneous, iso- to hypoechoic mass in the testis and is indistinguishable from a testicular malignancy
colour Doppler may show a central feeding vessel that branches out toward the rest of the splenic tissue
MRI
may show continuous or discontinuous relation between ectopic splenic tissue and gonad
Nuclear medicine
if suspected prospectively, Tc99m-sulfur colloid may be used to identify ectopic splenic tissue in a gonad
Treatment and prognosis
Splenogonadal fusion is thought to have a benign prognosis, but is rarely diagnosed before orchidectomy.
Differential diagnosis
References
- 1. Bhatt S, Rubens DJ, Dogra VS. Sonography of benign intrascrotal lesions. Ultrasound Q. 2006;22 (2): 121-36. Pubmed citation
- 2. Stewart VR, Sellars ME, Somers S et-al. Splenogonadal fusion: B-mode and color Doppler sonographic appearances. J Ultrasound Med. 2005;23 (8): 1087-90. Pubmed citation
- 3. Ando S, Shimazui T, Hattori K et-al. Splenogonadal fusion: case report and review of published works. Int. J. Urol. 2006;13 (12): 1539-41. doi:10.1111/j.1442-2042.2006.01598.x - Pubmed citation
- 4. Vikram S. Dogra, Gregory T. MacLennan. Genitourinary Radiology: Male Genital Tract, Adrenal and Retroperitoneum. ISBN: 9781447148999
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