Misdiagnosis and mistreatment of transverse testicular ectopia-two case report and review of literature

Abstract

Rationale: Transverse testicular ectopia (TTE) is a rare congenital malformation with a high rate of misdiagnosis and mistreatment before operation, which cannot be diagnosed even during operation due to lack of knowledge. Patient concerns: Two patients with ectopic testes who were misdiagnosed as right inguinal hernia for the first time and underwent surgery. The “ovary” and “testicle” like structures was seen in the right inguinal region during the first operation. After being transferred to our hospital for laparoscopic surgery, it was found that the left spermatic cord and testis were transversely transverted to the right, the left testis was fixed at the right inner ring, and agglomerated soft tissue could be seen in the right inguinal canal, which was suspected to be Muller tube. Diagnoses: Based on preoperative images and intraoperative findings, both cases were diagnosed with Transverse testicular ectopia (TTE). The postoperative pathology report for the second patient revealed the presence of an in situ spermatogenic cell tumor in the ectopic testis. Interventions: Preperitoneal tension-free repair of right inguinal hernia and resection of left cryptorchidism were performed on the 2 patients. Outcomes: Postoperative pathology of the first patient confirmed that the resected specimens contained tubal-like and uterine-like structures. The postoperative pathology of the second patient showed that the resected tissue consists of immature testis, epididymis, uterus and seminal vesicle glands, in which an in situ spermatogenic tumor could be seen in the testicular tissue. Postoperative diagnosis: left transversal testicular ectopia and right indirect inguinal hernia. Lessons: The clinical misdiagnosis and mistreatment rate of TTE is very high. Once the patients with cryptorchidism complicated with inguinal hernia are found in clinic, the possibility of the disease must be considered. For the patients whose cryptorchidism does not descend into the ipsilateral scrotum and it is difficult to diagnose, laparoscopy can be used for both diagnosis and treatment. If a patient has both inguinal hernia and cryptorchidism, it is crucial to rule out a diagnosis of TTE to prevent misdiagnosis and inappropriate treatment.

A Case of Mammary-Type Myofibroblastoma Occurring in the Inguinal Region

“…When a soft tissue tumor develops in the inguinal region, it may be mistakenly diagnosed as an inguinal hernia, especially when asymptomatic. Particularly, characteristic imaging findings of MTMF have not been reported, making preoperative diagnosis difficult [4,8]. This is thought to be due to variations in the amount of intervening adipose tissue in this condition, leading to differences in MRI findings among cases.…”

“…As for the etiology, some hormonal abnormalities have been implicated. When a soft tissue tumor develops in the inguinal region, there may be cases where it is mistakenly diagnosed as an inguinal hernia, especially when asymptomatic [4]. Additionally, other diseases, such as aneurysms, varicose veins, endometriosis, and hydrocele of the canal of the nuck, require a differential diagnosis from an inguinal hernia.…”

Transverse testicular ectopia with an inguinal hernia: A rare case report

“…The etiology of TTE is unclear but there are several theories, including abnormal development of the genital ridge, incomplete Mullerian duct degeneration, abnormal development of the ipsilateral testicular gubernaculum, obstruction or atresia of the secondary inguinal ring and abnormal connections between the vas deferens and other structures [ 9 ].…”