Discontinuous splenogonadal fusion: new sonographic findings

Abstract

Splenogonadal fusion is an uncommon cause of scrotal mass in children that is rarely diagnosed before surgery. Occasionally it leads to unnecessary orchiectomy. We report a case highlighting US findings that could help with correct diagnosis.

Untitled

“…Splenogonadal fusion can be subgrouped based on the attachment to the spleen into a continuous and discontinuous type. 4,7 The continuous type represents approximately 55% of cases and is characterized by a connection between the spleen and the gonads through a cord of splenic or fibrous tissue. The discontinuous type (44% of cases) has no direct connection of the gonads with accessory spleens or ectopic splenic tissue.…”

“…The discontinuous type (44% of cases) has no direct connection of the gonads with accessory spleens or ectopic splenic tissue. 3,7 The exact pathogenesis for splenogonadal fusion is not yet understood, but it is thought to develop between the fifth and the eighth week of gestation based on the close location between the splenic tissue and left gonadal ridge. When the spleen develops in the dorsum of the mesogastrium from a group of mesenchymal cells, the gonads start to develop in the posterolateral wall of the embryo at the same time.…”

“…Furthermore, subsequent inflammation or adhesions on the peritoneal surface may facilitate splenogonadal fusion. 4,[7][8][9] This condition commonly presents as an inguinal hernia or a testicular mass and may be misdiagnosed with testicular malignancy. In the literature, four cases of malignancies associated with splenogonadal fusion have been described.…”

“…In case of insufficient resolution, a computed tomography or magnetic resonance imaging, and lastly technetium-99m spleen scintigraphy, which is the most recommended tool in the literature, may be performed. 3,7 However, the most useful diagnostic test is surgical exploration. In our case, the availability of frozen section in first operation saved the child from orchiectomy, but frozen section may not be available at all times.…”

Name That Lump

“…It is rarely diagnosed preoperatively and more commonly found in men than women (Li, Luan, Ma, & Chen, 2013;Milliken, Cherian, Najmaldin, & Powis, 2007;Zhang, Tong, & Zhang, 2013). As the testis starts to descend at Week 8, it pulls the splenic tissue along with it (Ferron & Arce, 2013;Lin, Lazarowicz, & Allan, 2007;Milliken et al, 2007). It most often occurs on the left side as a firm, nontender mass (Kocher, Tomaszewki, Cronson, Altman, & Kutikov, 2014).…”