Right testicular necrosis and left vanishing testis in a neonate

We describe a rare case of right testicular necrosis and left vanishing testis in a neonate. The patient presented with a right swollen testis and left non-palpable testis at birth. Exploratory laparotomy was performed at 23 days after birth, and the right testis was extirpated because of extensive necrosis due to torsion of the spermatic cord. Histopathological examination revealed a massively necrotic testicular structure with hypertrophy of Leydig cells. Hypergonadotropinemia was also recognized before operation. On laparoscopy at the age of 5.3 years, a normal left vas deferens and spermatic vessels exiting through the internal inguinal ring were confirmed, although the patient's left testis was not found in the intraperitoneal cavity. An hCG test demonstrated no response of serum testosterone. These findings suggested a diagnosis of left vanishing testis due to testicular regression. We therefore speculated that bilateral asynchronous testicular torsion had occurred prenatally in this patient.     

小儿睾丸扭转的诊断与治疗

目的提高对小儿睾丸扭转的临床诊断和治疗水平。方法回顾性分析42例睾丸扭转的临床资料,年龄4～15岁,平均8.5岁。左睾丸27个,右睾丸15个。初诊时间<6h10例,6～24h26例,6例超过24h。初诊确诊为睾丸扭转24例,延误诊断18例(本院7例,外院11例)。结果8例发病后6h就诊者,给予手法复位成功;34例发病时间>6h者手术探查,18例手术探查睾丸已坏死,而行睾丸切除。结论彩色多普勒超声是首选辅助检查方法。提高首诊诊断正确率将有助于扭转睾丸的获救。主张尽早手术及预防性对侧睾丸固定。     

Segmental testicular infarction in a young man simulating a testicular tumor

A 19-year-old boy presented with a 48-hour history of acute onset severe right scrotal pain with minimal scrotal swelling. High-frequency US including color Doppler demonstrated a wedge-shaped, heterogeneous, avascular testicular mass diagnosed preoperatively as a segmental testicular infarction (STI). This was proved at surgery and subsequent histology. The preoperative diagnosis of STI was suggested based on the young man’s presentation of severe pain and the sonographic appearance of the mass. Entertaining the preoperative diagnosis of STI from a testicular tumor is important for testis-sparing surgery even though STI in the pediatric age group is extremely rare.     

Female phenotype in a male child due to 17-alpha-hydroxylase deficiency.

The discovery of testicles in a 3-year-old girl with XY karyotype led to a diagnosis of testicular feminization. Subsequently, however, hypokalaemia, hypertension, and severe prostration during a mild infection suggested adrenal involvement, and investigations showed a 17-alpha-hydroxylase deficiency. Diagnosis of testicular feminization should not be made without excluding a defect of testosterone synthesis.     

Female phenotype in a male child due to 17-alpha-hydroxylase deficiency

The discovery of testicles in a 3-year-old girl with XY karyotype led to a diagnosis of testicular feminization. Subsequently, however, hypokalaemia, hypertension, and severe prostration during a mild infection suggested adrenal involvement, and investigations showed a 17-alpha-hydroxylase deficiency. Diagnosis of testicular feminization should not be made without excluding a defect of testosterone synthesis.     

Cystic dysplasia of rete testis associated with ipsilateral renal agenesis. Case report

Cystic dysplasia of the rete testis is a rare abnormality often associated with the ipsilateral agenesis of kidney. This malformation is due to a development defect of the mesonephric duct which is the cause of both the dilation of the testicular rete testis and renal agenesis. A case of this rare malformation, showing all the peculiarities described in the medical literature, is presented. A 3 years-4 months boy was examined for an asymptomatic left scrotal mass; thus, he underwent ultrasonography, which showed a multiple tubular and cystic dilatation of left rete testis, associated with the absence of left kidney, afterward confirmed by MAG3-radionuclide scan. Diagnosis was also validated by testicular biopsy. No surgery was required. The child is nowadays under observation and at 2-years follow-up he doesn't show any symptom. According to many authors, a conservative treatment of this benign congenital abnormality is suggested as well as serial ultrasonography to monitor the growth of the testicular mass, which in a longest follow-up, could require surgery. Malignant transformation nor infertility have never been described.     

Antenatal ultrasound visualization of left testis that then vanished after birth

A 10‐month‐old infant was referred for disappearance of the left testis, which had been confirmed as present on antenatal ultrasound at 38 weeks of gestation, as well as at the newborn physical exam and the 4 month exam. The right testis was enlarged, whereas the left testis was palpated as a nubbin. The right testis measured on ultrasound was 1.6 × 0.8 × 1.0 cm; the testicular volume was 0.67 cm³. The left nubbin was hyperechoic, and accurate measurement of testicular components was difficult. At the age of 1 year 8 months, with the diagnosis of left vanishing testis, inguinal exploration was undertaken to rule out intra‐abdominal cryptorchidism. A fibrous nodule that connected to the spermatic vessels and the vas deferens was resected. Histopathology indicated a testicular remnant containing seminiferous tubules, hemosiderin deposits, calcification and marked fibrosis of the stroma, suggesting hemorrhagic infarction in utero.     

Vascular thrombosis and recanalisation: a useful additional marker for testicular regression syndrome

Antenatal ischaemic necrosis has been suggested as the cause for testicular regression syndrome, but the histological evidence for this has only been indirect. Two patients with unilateral testicular regression syndrome with vascular changes of thrombosis and recanalisation in the spermatic vessels are reported, demonstrating another histological marker that can be used in establishing the diagnosis of this disorder.     

小儿隐睾扭转的诊治体会

目的：探讨小儿隐睾合并扭转的临床诊治经验。方法回顾性分析2008年7月至2013年12月我们收治的14例小儿隐睾合并睾丸扭转病例的临床资料,其中左侧9例,右侧5例;左侧9例中,2例为双侧隐睾;右侧5例中,1例术中及术后病理检查证实为隐睾合并睾丸成熟畸胎瘤。14例均为单侧隐睾扭转。患儿年龄4岁至11岁5个月,平均3．1岁。结果14例患儿中,11例行扭转坏死睾丸切除术,3例行扭转睾丸复位＋下降固定术,患儿均同期行健侧睾丸固定术或健侧睾丸下降固定术。术后经2个月至5年随访,11例睾丸切除患儿健侧睾丸发育良好,血清睾酮水平正常;3例睾丸下降固定术患儿中,2例睾丸发育良好,1例合并睾丸畸胎瘤患儿经保睾手术后患侧睾丸发育较小,无肿瘤复发。结论早期诊断和及时手术治疗是提高隐睾并扭转患儿睾丸存活率的关键。     

The protective effect of dexpanthenol on testicular atrophy at 60th day following experimental testicular torsion

Despite the prompt diagnosis and treatment of testicular torsion (TT), there are problems with fertility and atrophy after testicular salvage. Dexpanthenol (Dxp) is the biologically active alcohol of pantothenic acid (PA). Dxp is converted to PA in tissues. PA increases the content of reduced glutathione (GSH), Coenzyme A and ATP synthesis in cells. GSH and glutathione-dependent peroxidases (GPX) are the major defense systems against oxidative stress. GPX-4 is the major antioxidant in testicular tissue. However, the activity of GPX-4 appeared and increased only after puberty. We investigated the effect of Dxp on testicular atrophy after TT at the 60th day. Rats were separated randomly into four groups. Group C: control group, group Td: torsion + detorsion, group Sal: torsion + saline + detorsion, group Dxp: torsion + Dxp + detorsion. The left testis was rotated 720° for 2 h. In group Sal, normal saline and in group Dxp, Dexpanthenol were injected intraperitonally, 30 min before detorsion. After 60 days, the testicular weights and volumes were measured. Histopathology of the left testis was evaluated with mean seminiferous tubular diameter (MSTD) and mean testicular biopsy score (MTBS). The left (torsed) testicular weight and volume of groups Td and Sal were significantly lower compared to group Dxp. The MSTD and MTBS of group Td and Sal were significantly lower than group Dxp. Contralateral testicular weight and volume of groups Td, Sal and Dxp had no significant difference compared to the control group. Dxp significantly prevented testicular atrophy after 60 days of TT. Dxp has FDA approval, is safe, cost effective and readily available. Its relevance for clinical trials may especially be for the problem of testicular atrophy catastrophe, seen very frequently following testicular salvage.     

Simple cyst of the testis: a rare and benign cause of testicular swelling in infancy

We report a five-month-old boy who was referred to the hospital with a presumptive diagnosis of hydrocele of the cord. Ultrasonography revealed a cystic mass within the left testis. A complete removal of the cystic mass was done. Histopathological diagnosis was simple cyst of the testis. This rare lesion should be considered in the differential diagnosis of cystic testicular lesions in infancy. The treatment of choice is simple enucleation of the cyst with sparing of the testis and related structures.     

Total laparoscopic correction of transverse testicular ectopia

Transverse testicular ectopia is a well-described, rare congenital abnormality of testicular maldescent, in which both testes descend through one inguinal canal. There have been few reports on the laparoscopic diagnosis and laparoscopy-assisted management of this condition. We present a case of a 5-year-old boy who underwent laparoscopy for a right impalpable testis. During the procedure, the right testis was identified at the left internal ring. The common investing meso-orchium was divided and the right testis was brought down through the right inguinal canal laparoscopically. As far as we are aware, this is the first case of transverse testicular ectopia managed entirely laparoscopically.     

Primary testicular Burkitt lymphoma in a child

A 13-year-old boy was referred to the authors' hospital following a right inguinal orchiectomy for a right scrotal mass. Histopathological examination revealed Burkitt lymphoma. The left testis was found to be small with heterogeneous parenchyma by scrotal ultrasound (US) and other systemic investigations were negative for lymphoma involvement. Ultrasound-guided fine-needle aspiration biopsy showed no evidence of involvement in the left testis. Considering stage I Burkitt lymphoma, chemotherapy was started. Following the first course, US findings changed: the volume of the left testis decreased and the parenchyma became homogeneous. The left testis was considered to be involved by lymphoma at initial diagnosis and chemotherapy was intensified. At the end of 5 months of chemotherapy the left testis was again heterogeneous in US. A wedge-biopsy was negative for lymphoma. The patient is under regular follow-up and is in complete remission 19 months after the end of chemotherapy. Primary testicular lymphoma is quite rare in children and experience is limited. Changes in testicular size and parenchyma by US should not necessarily indicate involvement by lymphoma in pubertal boys.     

PRIMARY TESTICULAR BURKITT LYMPHOMA IN A CHILD

A 13-year-old boy was referred to the authors' hospital following a right inguinal orchiectomy for a right scrotal mass. Histopathological examination revealed Burkitt lymphoma. The left testis was found to be small with heterogeneous parenchyma by scrotal ultrasound (US) and other systemic investigations were negative for lymphoma involvement. Ultrasound-guided fine-needle aspiration biopsy showed no evidence of involvement in the left testis. Considering stage I Burkitt lymphoma, chemotherapy was started. Following the first course, US findings changed: the volume of the left testis decreased and the parenchyma became homogeneous. The left testis was considered to be involved by lymphoma at initial diagnosis and chemotherapy was intensified. At the end of 5 months of chemotherapy the left testis was again heterogeneous in US. A wedge-biopsy was negative for lymphoma. The patient is under regular follow-up and is in complete remission 19 months after the end of chemotherapy. Primary testicular lymphoma is quite rare in children and experience is limited. Changes in testicular size and parenchyma by US should not necessarily indicate involvement by lymphoma in pubertal boys.     

Idiopathic testicular infarction in a boy initially suspected to have acute epididymo-orchitis associated with mycoplasma infection and Henoch-Schönlein purpura

Idiopathic testicular infarction without torsion of spermatic cord is a rare condition. We present a 12-year-old boy originally suspected of acute epididymo-orchitis, but subsequently an orchiectomy was necessary owing to unpredicted testicular infarction not associated with torsion. Elevation of immunoglobulin M against mycoplasma, reduction in serum factor XIII and the presence of sufficient blood flow detected by color Doppler ultrasonography upon initial manifestation suggested that the boy was affected by epididymo-orchitis associated with Henoch–Schönlein purpura or mycoplasma infection. However, progressive testicular enlargement was observed and subsequently testicular blood flow became barely detectable. Our case indicates that the presence of sufficient blood flow upon initial diagnosis in the affected testis does not necessarily exclude infarction and continuous monitoring of blood flow may be required to avoid radical orchiectomy.     

儿童精索静脉曲张130例临床分析

目的总结儿童精索静脉曲张的临床特点及诊治体会，探讨其所致睾丸差异生长的临床意义。方法回顾性分析作者收治的130例精索静脉曲张患儿临床资料。结果130例中，左侧128例，双侧2例，发病年龄10岁以上者120例。首发症状为阴囊内包块者109例，体检发现者15例，阴囊疼痛、坠胀不适4例，左右阴囊大小不一2例。超声检查提示合并症以睾丸微石症最常见。130例均予手术治疗，其中开放手术13例，腹腔镜手术117例。术后随访105例无复发及睾丸萎缩。92例记录睾丸大小的患儿中，51．1％存在双侧睾丸差异生长，且随着临床分度的递增而睾丸差异生长显著。结论儿童精索静脉曲张以左侧多见，好发于10岁以上儿童，极少有自觉症状，诊断主要依靠体格检查及彩超，治疗上以手术为主，腹腔镜手术有望成为首选。睾丸差异生长是儿童精索静脉曲张较可靠的手术指征，合并睾丸微石症的发生率仍须进一步研究。     

Osseous presentation of Hodgkin's disease: a case report and review of the literature

The bone involvement in the later stages of Hodgkin's disease is an expected phenomenon, but it is very rare in early stages of the disease. About 49 cases of Hodgkin's disease presenting with bone involvement have been reported in the literature. We reported a 14-year-old boy initially evaluated with pain localized at the left ilium. Although all the radiological examinations suggested an osseous anomaly, histopathologic evaluation of the pelvic lymphadenopathies provided definite diagnosis of the disease. We discuss the possible differential diseases and review the literature regarding the osseous presentation of Hodgkin's disease.     

A boy with Leydig cell tumour and precocious puberty: Ultrasonography as a diagnostic aid

A 7 5/12 year-old boy developed pseudoprecocious puberty. The diagnosis of Leydig cell tumour was suggested by clinical and hormonal findings and greatly facilitated by ultrasonographic investigation of the testes. Surgical exploration was in keeping with the diagnosis and the tumour was removed. Orchidectomy was not necessary. It appears that ultrasonography may be very useful in diagnosing a testicular tumour. It facilitates surgical intervention since it permits localization of the lesion which is usually very small and limited to a small part of the testis, as in this case.     

Scrotoshisis,bilateral extra-corporeal testicular ectopia and testicular torsion

Although anomalies of testicular descent are common, scrotoschisis and extracorporeal testicular ectopia is rare with only 3 reported cases in literature. This is a report of a neonate presenting with scrotoschisis and bilateral extracorporeal testicular ectopia. The right testis underwent torsion before presentation, resulting in gangrene of that testis, requiring orchidectomy. The scrotum was explored and the viable left testis placed in the scrotum and fixed in that position. The left testis has remained normal at 9 months of follow up. The possible embryology and management of this curious anomaly is discussed.     

Granulomatous orchitis in a pre-pubertal school-aged child: Differential diagnosis dilemmas

A 6-year-old male presented with testicular growth and persistent chronic orchiepididymitis with high inflammatory markers (C reactive protein and erythrocyte sedimentation rate). Biopsies of the testes and epididymides showed bilateral epididymal and testicular granulomata, testicular fibrosis and chronic inflammatory infiltration, and the histological diagnosis was granulomatous orchitis. The symptoms receded with oral corticosteroids. Although rare, granulomatous orchitis is a possible diagnosis in children presenting testicular enlargement. It is important to differentiate it from testicular tumors (if necessary with testicular biopsy) and to investigate its association with systemic vasculitis and infectious diseases.