Download a case of polyorchidism: evaluation with magnetic resonance

Anatol J Clin Investig 2009:3(1):74-76
A CASE OF POLYORCHIDISM: EVALUATION WITH MAGNETIC RESONANCE IMAGING
Melike Rusen METİN1, Nurdan CAY1, Ozgur TOSUN1, Mustafa KARAOĞLANOĞLU1
1
Ataturk Education and Research Hospital, Department of Radiology, Ankara.
Abstract
Polyorchidism is a rare congenital abnormality of the reproductive system. Although ultrasonography is the first
diagnostic tool, MRI is generally needed for further anatomical and tissue characterization. We describe here a
case where a patient with a palpable mass in his left hemiscrotum underwent radiological diagnosis of an
accessory testis with MRI. (Anatol J Clin Investig 2009:3(1):74-76).
Polyorchidism is a rare congenital abnormality of
the reproductive system. Transverse duplication
of genital ridge and primordial gonad with two
ridges are the possible explanations for the
embryological pathogenesis [1]. Although
complications such as torsion may develop, a
large proportion of patients have been diagnosed
by various radiological methods such as
ultrasonography and magnetic resonance
imaging (MRI) after determination of a palpable
mass [2]. Herein, we described a case with
polyorchidism diagnosed by MRI. MRI findings of
that congenital abnormality were also described.
Case report
A 20-year-old male was admitted to the
department of urology with a palpable mass in
his left hemiscrotum apart from the left testis. A
relatively firm and ovoid mobile mass 2 x 2 cm in
size was detected in physical examination.
Scrotal ultrasonography was performed. Normal
testicular tissue and normal testicular tissue with
a well circumscribed accessory homogenous
tissue having the same echogenicity 2.5 x 2 cm
in size were determined on the right and the left
hemiscrotum, respectively. Accessory mass had
no a separate stalk. Accessory mass had also
blood flow on the color Doppler flow image.
Physical examination and laboratory tests were
otherwise normal. For further anatomical tissue
characterization, MRI was performed (Phillips
Gyroscan Intera 1.5T, Best, The Netherlands). A
testis with a normal shape and size was shown
in the right hemiscrotum. However, an accessory
testis and a normal testis on a side by side
position were shown in the left hemiscrotum.
Accessory one was smaller. Both are isointense
on transverse, coronal, and sagittal T1- and T2weighted images. Transverse and coronal T1weighted turbo spin echo images showed both
isointense testes on both side (Figure 1 A and B).
However, transverse and coronal T1-weighted
turbo spin echo images with contrast
enhancement showed an accessory testicular
tissue apart from the left testis in the left
hemiscrotum after administration of gadolinium
(Figure 2 A and B). Two testicular tissues were
also seen in the left hemiscrotum on sagittal T2weighted turbo spin echo imaging (Figure 3). In
addition, there were single epididymide and vasa
deferentia on the left side (Type A3
polyorchidism).
Discussion
Polyorchidism is a rare congenital abnormality of
the urogenital system. As in the present case,
triorchidism is the most frequent presentation
and the supernumerary testis is most often
located in the left side of the scrotum [3]. Type
A3 is the most frequently seen [4]. Two thirds of
supernumerary testes biopsied are histologically
normal [5]. Inflammation, hydrocele, torsion,
varicocele, spermatocele, cysts, and malignant
or benign tumor should be thought in differential
diagnosis. Ultrasonography is the initial
diagnostic tool for scrotal pathologies. In
particular, the differentiation of intra and
extratesticular masses has a sensitivity of 80%–
95% [6]. As seen in our patient, sonographic
appearance of the supernumerary testes shows
an echo pattern identical to that of the ipsilateral
testes [7]. Ultrasonography has been generally
insufficient in definite anatomical and tissue
characterization of testicular masses. Therefore,
further radiological tools have been applied such
as MRI. MR imaging allows characterization of
scrotal
masses
as
intratesticular
or
extratesticular and can demonstrate various
types of lesions and tissue, including cysts or
fluid, solid masses, fat, and fibrosis. MRI is the
most reliable and sensitive diagnostic imaging
technique in the classification of intra-scrotal
pathology [8]. Scrotal MRI is not operator
dependent and has the further advantage of
multiplanar imaging with higher soft tissue
resolution and contrast. MRI is also an effective
non invasive method of accurately detecting
polyorchidism and shows intermediate signal on
T1- weighted images and high signal intensity on
T2-weighted images [9]. Many authors have
argued that in the absence of any apparent
Nurdan CAY
Ataturk Education and Research Hospital, Department of Radiology, Ankara.
e-mail: [email protected]
A Case of Polyorchidism: Evaluation with Magnetic Resonance Imaging
malformation or evidence of testicular tumor,
exploration and biopsy are unnecessary.
Therefore, non-invasive radiological follow-up
with MRI has been proposed.
In conclusion, ultrasonography should be the
initial test in scrotal pathologies. However, MRI
should be performed in difficulties with
ultrasonography. T2-weighted images are more
diagnostic than T1-weighted ones in the
diagnosis of the supernumerary testis.
Figure 1. Transverse (A) and coronal (B) T1-weighted turbo spin echo images show both the left and the right
testes in their respective hemiscrotum.
Figure 2. Transverse (A) and coronal (B) T1-weighted turbo spin echo images with contrast enhancement show
two testicles on the left side and one normal testis on the right side.
Figure 3. Sagittal T2-weighted turbo spin echo MRI showing two testes within the left hemiscrotum. The
supernumerary testes have the same MR imaging characteristics as the normal testes.
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METİN et al.
Anatol J Clin Investig 2009:3(1):74-76
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