A Rare Variation of Transverse Testicular Ectopia (TTE) in a Young Adult as an Incidental Finding during Investigation for Testicular Pain

Abstract

Transverse testicular ectopia (TTE) with fused vas deferens is an extremely rare clinical entity. Herein, we present a case of a 19-year-old patient with persistent left testicular pain lasting for a week. Clinical examination revealed an empty right hemiscrotum, a normal left-sided descended testis, and in close proximity a mass-like structure resembling testicular parenchyma. Laboratory tests were significant for elevated follicle-stimulating hormone (FSH), while sperm count revealed azoospermia. Ultrasound imaging (US) of the scrotum demonstrated the presence of both testes in the same left hemiscrotum with varicocele and no signs of inguinal hernia. Magnetic resonance imaging (MRI) of the penis and scrotum revealed TTE with a single, fused vas deferens, and hypoplastic seminal vesicles. Surgical intervention by means of microsurgical sperm retrieval and transseptal orchidopexy were considered but not performed, primarily owing to the patient's unwillingness and to a lesser extent due to the restriction that the short and fused vas would pose in an attempt to transpose the ectopic testis. Therefore, an annual follow-up was recommended.

Seminoma in a Transverse Testicular Ectopia: A Rare Case Report

“…Gkekas et al 7 have reported a classification system of TTE. These classifications are as follows: type I, associated with inguinal hernia; type II, accompanied by Mullerian duct remnants; and type III, associated with other genitourinary anomalies other than Mullerian duct remnants.…”

“…According to the literature, Mullerian duct remnants and other genitourinary anomalies must be excluded in a patient with TTE after surgical orchiopexy as well as long-term follow-up. 7…”

“…The differential diagnosis included germ cell tumors of the testis, fibrous pseudotumor of the testis, and sex cord stromal tumors. 4,7 Usually, hypercellular malignant tumors show limited diffusion on DWI. The addition of DWI to conventional MRI sequences has been shown to be helpful in differentiating malignant urogenital tumors from benign neoplasms.…”

Remnant mullerian structure with transverse testicular ectopia

“…Classical presentation is an undescended testis with contralateral hernia. 1 The first descriptions were documented by Von Lenhossek in 1886. 2…”

“…It is characterized by migration of one testis to the contralateral route of testicular descent. 1 TTE is associated with a multitude of abnormalities including hernia, hypospadias, and persistent Mullerian structures. 1 , 2 , 3 Our case is unique in terms of age of presentation and the full development of external genitalia.…”