Triorchidism - A Case Report of a Rare Congenital Anomaly.

ABSTRACT

Polyorchidism is a rare congenital anomaly usually found on the left side and frequently associated with inguinal hernia, testicular torsion, and cryptorchidism. An increased risk of testicular malignancy has been reported in cases of Polyorchidism.1 It may be detected as a scrotal mass in children or may go undetected till adult life and found incidentally. Different classifications of supernumerary testis exist depending on the location of the extra testis and its relationship to the native testis and the vas deferens. The most commonly occurring presentation is one of an extra testis or triorchidism on the left side. We report here a case of Triorchidism in a young male patient who was clinically suspected to have an epididymal cyst.Polyorchidism, or supernumerary testicle is the presence of more than two testes, most frequently presenting as triorchidism1 It is an extremely rare congenital anomaly of the urogenital system and there are only about a hundred documented cases in literature. We describe here a rare case of Triorchidism in a 21-year-old male patient who presented with long standing left sided painless scrotal swelling, clinically suspected to be an epididymal cyst and evaluated using high resolution Ultrasonography including Colour Doppler and Magnetic Resonance Imaging (MRI). Ultrasound demonstrated the supernumerary testis to be located posterosuperior to the native left testis with each having their own epididymal and vas deferens connection. MRI confirmed the presence of supernumerary testicle with an abnormal signal intensity on T2W images appearing homogenously hypointense in contrast to the hyperintense signal on T2W images of the two normal testicles leading to the suspicion of the occurrence of seminomatous transformation of the testicle. The finding of necrotic enlarged iliac, inguinal, pre and para aortic lymph nodes both on ultrasonographic and MRI evaluation further supported the suspicion of a seminomatous transformation.