A bolt from the blue in a testicular mass - continuous Splenogonadal fusion with maturation arrest.

Splenogonadal fusion is an infrequent cause of testicular or scrotal swelling with less than 250 cases reported. We report the case of a 27-year-old male who presented with painless scrotal swelling. The sonography showed a homogeneous, well-encapsulated left extratesticular mass, which was surgically removed. The gross examination revealed a grey-brown tissue below the left testis. The microscopy of the grey-brown mass revealed splenic tissue, and the testis showed maturation arrest, resulting in the diagnosis of splenogonadal fusion. These can be easily mistaken for a tumor, especially in this age group. Reporting such an entity increases awareness among clinicians, radiologists and pathologists, which will aid in preventing an orchiectomy for these patients.

A bolt from the blue in a testicular mass - continuous Splenogonadal fusion with maturation arrest

ABSTRACT Splenogonadal fusion is an infrequent cause of testicular or scrotal swelling with less than 250 cases reported. We report the case of a 27-year-old male who presented with painless scrotal swelling. The sonography showed a homogeneous, well-encapsulated left extratesticular mass, which was surgically removed. The gross examination revealed a grey-brown tissue below the left testis. The microscopy of the grey-brown mass revealed splenic tissue, and the testis showed maturation arrest, resulting in the diagnosis of splenogonadal fusion. These can be easily mistaken for a tumor, especially in this age group. Reporting such an entity increases awareness among clinicians, radiologists and pathologists, which will aid in preventing an orchiectomy for these patients.

Predicting malignancy in small testicular lesions.

Introduction: Small testicular lesions ≤20 mm (STL) detected by ultrasound (US), usually non-palpable, have been reported to be benign in up to 80% of cases. Thus, partial orchiectomy with or without frozen section examination and surveillance has been advocated for these kinds of lesions. We seek to report the proportion of benign lesions in testicular tumors ≤20 mm detected by US in our population and explore the predicting factors of malignancy. Material and methods: A retrospective descriptive study of orchiectomies performed for testicular tumors in patients older than 15 years between 2005 and 2019 was performed, including all patients with lesions ≤20 mm on US imaging. Results: A total of 70 patients with STL were included (mean age 34.6 ±10.8 years). Overall, 69% of the lesions were malignant while the smallest lesions (≤10 mm) showed 61% of cancer. Moreover, in the subgroup of non-palpable lesions ≤10 mm, 50% were malignant. Multifocal tumors were found in 18 subjects with a malignancy rate of 88%. There was a significant association between maximum size on US, multifocality and malignancy. Neither tumor markers nor palpability foretold a malignant lesion. A predictive model including size and multifocality was created showing a positive predictive value of 83.3%. Conclusions: US maximum size and multifocality were predictors of malignancy in STL. However, even the smallest lesions showed a 50% chance of being malignant, thus surgery with or without intraoperative biopsy is warranted in most cases.

Fusión esplenogonadal como causa de masa testicular pediátrica: Caso clínico / Splenogonadal fusion, a rare cause of pediatric testicular mass: clinical case

La fusión esplenogonadal es una variación anatómica infrecuente, con un pequeño número de reportes en la literatura. La estrecha relación entre el bazo y la gónada primitiva izquierda en un momento del desarrollo embrionario logra explicar la existencia de este fenómeno. Objetivo: Comunicar el primer reporte en la literatura nacional de fusión esplenogonadal. Caso clínico: Preescolar de 2 años 10 meses que consultó por aumento de volumen silente en testículo izquierdo estudiado mediante ecografía, la cual reveló una masa hipervascular en su polo superior. Se decidió su exploración quirúrgica donde se apreció una estructura sólida, bien adherida al teste, de superficie similar a la del hígado. Fue resecada y enviada a biopsia rápida la cual se informó como un tejido esplénico benigno. Discusión: La literatura revisada describe los aspectos más importantes de ésta entidad, su desarrollo embrionario, clasificación, presentación clínica, métodos diagnósticos y tratamiento. El conocimiento de esta condición por parte del equipo médico y su inclusión en el diagnóstico diferencial de masa testicular, permite tomar medidas diagnósticas en el intraoperatorio para un tratamiento conservador. Una vez establecido el diagnóstico, habitualmente en el intraoperatorio, es suficiente la enucleación completa del tejido esplénico, evitando orquiectomías innecesarias.

The splenogonadal fusion is a rare anatomical variation, with only a few reports in the literature. The close relationship between the spleen and the primitive left gonad in a specific moment of the embryonic development could explain this phenomenon. Objective: To point out the clinical presentation and treatment of this condition, through the first case published in our country. Clinical case: We report the case of a male child, 2 years 10-month-old, who consulted for silent swelling of the left testis, which Doppler ultrasound study revealed a hypervascular, polar mass. A surgical exploration was performed, and a solid, adherent, liver-like structure was observed over the testicle. The intraoperatory biopsy was informed as benign splenic tissue. Conclusion: The reviewed articles describe important information about the development, classification, presentation and management of this condition. The knowledge and inclusion of this condition in the differential diagnosis of pediatric testicular masses allows the medical team to choose for conservative therapeutic measures. Once the diagnosis is established, often intraoperatively, a complete resection of the splenic tissue is enough for these patients, avoiding an unnecessary orchiectomy.