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Technological Leadership

Patrick R. Meyers, RDMS, RVT
Swedish Medical Center
Englewood, Colorado, U.S.A.

A. Thomas Stavros, MD
Swedish Medical Center
Englewood, Colorado, U.S.A.

Polyorchidism, or duplication of the testicles, is a rare anomaly. A literature review indicates that there have been approximately 75 cases reported to date. Approximately 50% of the cases are in males between 15 and 25 years of age. Triorchidism is the most common number, and the left side is predominately affected. 30% are associated with ipsilateral inguinal hernia1.

Other associated pathologies include torsion of the ipsilateral testicle 2,3. Malignancy or malignant degeneration appears to occur in approximately 4-7% of cases and malignant types are seminoma, teratoma and choriocarcinoma. Commonly there is a single gonadal artery and varying degrees of function and spermatogenesis. Treatment options vary from very conservative to aggressive approaches, in which multiple biopsies are recommended to assure normalcy and rule out tumor3. Whether true cryptorchidism is debated in association with malignancy, ultra-high frequency is perfectly suited to image the supernumerary testicles, determine the existence of malignancy, determine blood supply with the uses of Color Flow (CF), Power Doppler (PD) and, if necessary, guide needle biopsy to areas of suspicion.

The Case Report
A 31-year-old man was referred to the ultrasound lab for a second opinion evaluation of a non-transluminating scrotal mass associated with minimal right hemiscrotal discomfort. Initial clinical diagnosis was spermatocele versus tumor. The patient denied acute trauma, viral disease or infection. The patient described a history of vigorous exercise associated with some right-sided discomfort

The patient was examined sonographically for inguinal or femoral hernia; Color Flow, Spectral Doppler and Power Doppler were employed for the existence of an inflammatory condition. No sonographic or duplex signs of inflammation were observed. The right testicle and adnexa were unremarkable. The left hemiscrotum revealed what appeared to be a supernumerary testicle. Each testicle was carefully examined to rule out malignancy and to observe blood supply. Attempts were made to image separate epididymie and ascertain whether the testicles were completely separate. Separation was determined (Fig. 1), but attempts to completely separate epididymie were unsuccessful. A transcrotal oblique view was obtained to secure a diagnosis of polyorchidism (Fig. 2). As monographic evidence revealed no pathology, the patient was followed conservatively.

image image
Fig. 1 Fig. 2

Polyorchidism remains a rare anomaly and unique find. Emphasis of diagnosis is concentrated on associated anomalies and concurrent pathologies including hydrocele, varicocele, torsion and malignancy4, with malignancy and torsion being of primary interest. Normal cells of Sertoli indicate spermatogenesis. Normalcy of testicular architecture and location4 are tantamount to a diagnosis of a normal variant. Although no infiltrative neoplasms were discussed in the reviewed literature, this pathology remains a concern. Infiltrative diseases must be considered and seems to lead to the more aggressive approach of biopsy to confirm the diagnosis. However, the advent of ultra-high frequency probes, with vastly expanded dynamic ranges, makes monographic evaluation a safe, inexpensive and highly accurate modality to accomplish the diagnosis. Color flow and Power Doppler can help accurately diagnose, in most cases, abnormalities of vascular supply; i.e. torsion. Expanded knowledge of the inguinal canal and apneurosis of surrounding musculature may confirm the etiology of nonspecific pain in the lower quadrants associated with common concurrent indirect inguinal hernia. Further study with expanded dynamic ranges and increased axial and lateral resolution may make biopsy for diagnosis unnecessary.

  1. "Sujka, SK et. al, Polyorchidism," Urology. 29(3):307-9,1987, March.
  2. "Polyorchidism with Testicular Teratoma, A Case Report," Journal of Urology. 124(6):930-1,1980, Dec.
  3. "Polyorchidism Review," American Family Physician. 38(3):153-6, 1988,Sept.
  4. "Abdominal Polyorchidism; An Unusual Variant," Journal of Urology. 140(3):582, 1988, Sept.

Print copies of these clinical papers are available from GE. Many of the figures are easier to read on the print copies than they are here. To receive your own copy, send email to GE and reference publication number 96-4529.

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