POLYORCHIDISM A Case Report and Review of Literature

• Published in: Nippon Hinyokika Gakkai zasshi Vol. 65; no. 3; pp. 181 - 188
• Main Authors: Toyoda, Yasushi, Maruyama, Kunio
• Format: Journal Article
• Language: Japanese
• Published: Japan THE JAPANESE UROLOGICAL ASSOCIATION 01.03.1974
• Subjects: Adult; Humans; Male; Testis - abnormalities; Testis - embryology
• ISSN: 0021-5287; 1884-7110
• DOI: 10.5980/jpnjurol1928.65.3_181

A 24-year-old man visited the hospital with the chief complaint of pain in the left abdomen, and was diagnosed as left ureteral calculus. On physical examination, the content in the right scrotum was normally palpated, but there were two testis-like tumors in the left side. The patient was almost normal on inspection, and there was no abnormality on radiographic examination of the urinary tract. When the left scrotum was opened, both tumors looked like testis in appearance, as shown in Fig. 1. The size of the tumor in the upper part was 2.0×2.5×1.8cm, and that in the lower part 2.0×2.5×1.8cm. Both were attached to the epididymis. There was one spermatic duct (Fig. 6, Type V). Specimens for histological examination were taken from both testes, and tumors were restored in the scrotum. Histologically, there was nearly normal capacity of spermatogenesis (Fig. 2). There have been only 6 reports in Japan including our case, on the histological observation of polymorphism. In foreign countries, there were 41 reports on polymorphism (Table 1). Based on these reports, the cases of polymorphism are summarized as follows: 1) There were many cases in which polymorphism was revealed when the patients visited hospitals because of torsion of the spermatic cord and were operated as inguinal hernia. Otherwise, it was revealed when the operation of inguinal hernia was performed. In Japan, 3 cases were revealed during operation for tumors, a case on operation for hydrocele testis, and a case on operation for retentio testis. 2) The age of the patients who were found to have polymorphism ranged from three months in the youngest to seventy-five years in the oldest. In addition, seventy percent of the patients with polymorphism were in their teens and twenties. In Japan, the ages of the patients were 9, 22, 24, 28 and 37-year-old. 3) There were three testes in all cases. 4) The lesion was in the left side in 67%. There were 3 cases with lesion in the left side and 2 cases in the right side in Japan. 5) There were various sizes, from the size seen only by histological observation to the normal size. However, most of them were smaller than normal testis, which were about 2 cm in length. 6) About 50% of testes were regarded as retention testis. Fig. 3 shows the location of testis. It is interesting that the embryological disturbance prevented testis from descending. Only one case was with retention testis in Japan. 7) The morphology of the polyorchism is various (Fig. 4). We classified it into 6 types, as shown in Fig. 5. Many cases belonged to I, II and V types. There were 1 case in the I type, 1 case in the II type and 2 cases in the V type in Japan. 8) In the function of spermatogenesis, the cases in which spermatogenesis was seen were 68% including the cases with scar. Of these cases, only 5 cases were regarded as normal. Spermatogenesis was seen in 3 cases, one of which revealed normal spermatogenesis. 9) Diagnosis was made histologically. 10) Torsion of the spermatic cord and inguinal hernia were often seen as complications. In addition, there were other complications such as hydrocele testis of the scrotum, epididymis and male sterility. There were also some reports on teratoma, choriocarcinoma and rhabdomyosarcoma as complications with tumors. 11) When bilateral testes were small, both should be excised. When only one testis was small, it should be excised. In the restoration, the testis should be fixed to prevent the torsion of the spermatic cord.