Presentation
Mild right scrotal discomfort. No fever or urinary complaints. History of blunt right scrotal trauma while playing soccer a few months ago.
Patient Data
Findings: Two small testes are seen in the right hemiscrotum. A geographical area of decreased echogenicity without any mass effect or significant internal vascularity is seen in the inferior right testis, close to the mediastinum testis. Normal looking solitary left testis.
Impression: Polyorchidism (triorchidism) with two small testes on the right side. A small avascular geographical area of decreased echogenicity is seen in the right inferior testis, which likely represents post-traumatic/ischemic changes; the possibility of a malignancy is less likely.
Findings: Two small complete testes are seen in the right hemiscrotum. A well-defined focal lesion with lobular outlines, measuring approximately 8 x 12 mm is seen in the right inferior testis. This lesion is mildly hyperintense on T1 and iso- hypointense on T2-weighted images to the surrounding testicular parenchyma. No diffusion restriction or internal enhancement is seen in this lesion; however, the adjacent testicular parenchyma shows mildly increased enhancement. No focal abnormality is appreciable in the right superior testis. Both right-sided testes have a separate epididymis and a vas deferens. The normal-looking solitary left testis. Minimal bilateral hydroceles.
Impression: Right-sided A1 triorchidism. A small well-defined non-enhancing lesion in right inferior testis, which is likely a sequel of previous ischemic/traumatic insult; the possibility of a mass lesion/tumor is unlikely.
Case Discussion
Polyorchidism (presence of more than two testes), is an uncommon developmental anomaly, due to abnormal division of the genital ridge (+/- Wolffian duct duplication) in fetal life. In the majority of the patients, the supernumerary testis is found within the scrotum. It is an asymptomatic condition in most patients and is usually discovered incidentally.
Depending on the reproductive potential of the supernumerary testis (presence/absence of epididymis and ductus deferens in the supernumerary testis), polyorchidism is classified into two major types A (A1, A2 and A3 subtypes), and B (B1 and B2 subtypes).
Triorchidism (three testes), is the commonest type of polyorchidism, with the supernumerary testis, being found on the left side (65% of the cases) and A3 (supernumerary as well as the normal ipsilateral testis sharing a common epididymis and a vas deferens) is the commonest subtype (90% cases) of polyorchidism.
This is a unique case of polyorchidism; i.e. right-sided triorchidism with A1 subtype (supernumerary testis with a separate vas deferens and epididymis from the ipsilateral normal testis).
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