Splenogonadal fusion: aiding detection and avoiding radical orchidectomy

Splenogonadal fusion is a rare benign congenital anomaly in which there is an abnormal connection between the gonad and the spleen. It was first described over 100 years ago with limited reports in the literature since then. Its similarity in presentation to testicular neoplasia poses a significant challenge in diagnosis and management, often resulting in radical orchidectomy. We present the case of a 31-year-old man who presented with a rapidly growing left-sided testicular mass and suspicious ultrasound findings; histology from the subsequent radical inguinal orchidectomy showed findings consistent with splenogonadal fusion. We describe points for consideration in the clinical history, examination and imaging that could suggest splenogonadal fusion, including preoperative technetium-99m-sulfur colloid imaging and intraoperative frozen section evaluation, which may confirm the diagnosis and prevent unnecessary orchidectomy.

Histopathological Scenario of Testicular Lesions with Few Uncommon Entities – 3 Years Study in a Tertiary Care Hospital

BACKGROUND The incidence of testicular malignancy has been increasing in men, orchidectomy is necessary for the removal of neoplastic lesions or in patients with chronic inflammatory conditions resistant to treatment. We wanted to evaluate the various histopathological patterns of lesions in testis. METHODS A retrospective study of 86 orchidectomy specimens over a period of three years with age wise distribution from March 2017 to February 2020 was done in the Department of Pathology, Guntur Medical College, Guntur. Histopathological slides stained with haematoxylin and eosin were retrieved and reviewed. Immunohistochemistry was done in two cases. RESULTS Of the 86 cases, 78 (90.7 %) cases were non neoplastic and 8 (9.3 %) cases were neoplastic. Youngest age in non-neoplastic group was four days and in neoplastic group was 18 years. The oldest age was 82 years in the non-neoplastic lesions and 60 years in the neoplastic lesions. Non neoplastic lesions were common in the 3 rd decade. In malignant lesions, highest number of cases was seen in the 6 th decade and equal distribution was observed in 3rd and 5th decade. Unilateral involvement was common than bilateral involvement. Out of all non-neoplastic lesions, undescended testis 20 (25.64 %) cases was the common finding followed by non-specific epididymo orchitis 19 (24.36 %) cases, abscess 14 (17.95 %) cases, torsion infarction 13 (16.67 %) cases, Leydig cell hyperplasia 4 (5.13 %) cases, 3 (3.85 %) cases each of tuberculous epididymo orchitis and granulomatous epididymo orchitis. 1 (1.28 %) case each of rare entities like vanishing testis and splenogonadal fusion were also found. Among the neoplastic lesions, all 8 cases were malignant tumours. Out of these malignant tumours, mixed germ cell tumours were seen in 3 (37.5 %) cases followed by seminomas 2 (25 %) cases, post pubertal teratoma 1 (12.5 %) case, non-Hodgkin’s lymphoma (NHL) 1 (12.5 %) case and primitive neuroectodermal tumour (PNET) 1 (12.5 %) case. CONCLUSIONS Histopathological examination on routine haematoxylin and eosin (H&E) stained sections primarily differentiate non neoplastic lesions from neoplastic group and benign tumours from malignant tumours as the treatment modality varies. Immunohistochemistry (IHC) is useful in the diagnosis of poorly differentiated small round cell tumours. KEYWORDS Orchidectomy Specimens, Neoplastic and Non-Neoplastic Lesions

Splenogonadal fusion: a case report and review of the literature

Background Splenogondal fusion (SGF) is a rare congenital anomaly characterized by abnormal association between the splenic tissue and the gonads or mesonephric remnants. SGF that requires separate two-stage laparoscopic staged Fowler-Stephen orchiopexy on both the left and right sides is extremely rare. SGF could be misdiagnosed as testicular malignancy and leads to unnecessary orchiectomy. Case presentation This is a case of an 8-month old male infant presented with bilateral cryptorchidism, B-mode ultrasound visualized the left and right testes in the lower abdominal cavity and the upper margin of the left testicle as a hypoechoic mass extending to the spleen, indicating an undescended right testis and possible SGF on the left side. Single-site laparoscopic examination confirmed the diagnosis of SGF on the left side and an undescended right testis. As both testes were high and the right spermatic vessel was poorly developed and short, a routine single stage orchiopexy would be difficult and risky, therefore, separate two-stage laparoscopic staged Fowler-Stephen orchiopexies for both sides were implemented. Stage 1 of the staged Fowler-Stephen orchiopexy for the right side was performed first without treating the left side, Stage 2 for the right side, separation of the left testis from the spleen as well as Stage 1 for the left side were performed 7 months later, and Stage 2 for the left side was performed 7 months after that. Follow-up ultrasound 1 year after the surgery revealed no obvious abnormalities in the shapes of the testes or their blood supply. This treatment strategy prevented unnecessary orchiectomy. Conclusions We reported a rare case of SGF that needed separate two-stage laparoscopic staged Fowler-Stephen orchiopexies for both sides, and a review of the recent literature. SGF is a rare congenital anomaly often diagnosed incidentally during exploration/surgery for scrotal swelling/mass, cryptorchidism or inguinal hernia in young patients. Surgeons, especially pediatric surgeons should be aware of this rare condition to avoid unnecessary, life-altering radical orchiectomy. When routine single stage orchiopexy is not feasible or risky for either side, separate two-stage laparoscopic staged Fowler-Stephen orchiopexies could be performed on both the left and right sides to avoid unnecessary orchiectomy.

Pathogenesis, Diagnosis, and Management of Splenogonadal Fusion: A Literature Review

Introduction. Splenogonadal fusion is a rare congenital anomaly, defined by the presence of ectopic splenic tissue caused by an abnormal connection between the spleen and the gonad or mesonephrotic derivatives during the embryonic period. Materials and Methods. By reporting an observational case and performing a review of the literature according to the CARE guidelines (using the PubMed database and guidelines from urology, general surgery, and pediatric learned societies), we present the embryological genesis of the splenogonadal fusion, the associated anatomical anomalies, and the diagnostic procedure. Observation. We report the case of a patient aged 45, with no notable history, reporting left testicular pain. A small nodule on the upper pole of the left testicular was clinically palpable. Tumor markers were normal, and scrotal ultrasound depicted a hypoechoic hypervascular nodule measuring 8∗6∗8 mm. After validation in a multidisciplinary oncology consultation meeting and opinion from a uro-andrologist expert, the patient underwent an inguinal lumpectomy with an extemporaneous examination which did not objectify any signs of malignancy. Ultimately, it is a normal spleen tissue in the testicular ectopic position. Discussion. Splenogonadal fusion corresponds to a rare congenital malformation; less than 200 cases have been published in the literature, most often affecting boys, with a sex ratio of 15/1. Two types are described, depending on the continuity of the link between the orthotopic spleen and the gonad: the continuous and discontinuous forms. In a third of the cases, there are associated congenital malformations and particularly in the continuous forms (44 to 50% of the cases): anomalies of the limbs, micrognathia, microgyria, and hepatic and digestive abnormalities. Cryptorchidism is associated with the continuous form in 31% of cases. The preoperative diagnosis remains difficult because of its morphological and clinical characteristics suggesting a tumor process.

A rare case of discontinuous type splenogonadal fusion in a 13 year old boy: a case report and review of literature

Splenogonadal fusion (SGF) is a rare developmental anomaly in which an abnormal connection between the splenic tissue and gonads or mesonephric derivatives is present. This entity often presents with scrotal mass, inguinal hernia, or cryptorchidism. Less than 200 cases have been reported since it was first described in 1883. It can be of continuous and discontinuous type based on the presence of a band of connecting splenic tissue. Report a rare case of discontinuous type of SGF in an adolescent male presenting as nonpalpable testis. On evaluation, ultrasonography (USG) and magnetic resonance imaging of abdomen and pelvis, his left scrotal testis was atrophied and right intra-abdominal undescended testis. This is the first reported case of SGF from Bosnia and Herzegovina. Laparoscopy was demonstrated to be the only accurate exploratory procedure for the diagnosis and surgical treatment of SGF with non‑palpable testis.