Polyorchidism: the case in a young male and review of the literature

Leung 5 created a four-group anatomical classification of polyorchidism based on testis embryology. Group one consists of polyorchidism with no vas deferens or epididymis in the supernumerary testis. Group two includes the testes that share these two mentioned structures with the ipsilateral testicle. The third is formed by testes with their own epididymis and sharing the vas deferens. Finally, group four corresponds to supernumerary testes with their own annexes. 5 Anatomical and functional classification proposed by Singer et al. 6 divides polyorchidism into two groups: group I, in which there is reproductive functionality, given that the tubules linking to the epididymis and vas are permeable. And group II, with infertile patients. In turn, both groups have two subgroups based on whether there is a scrotal location of the testis (IA, IIA) or an ectopic location (IB, IIB). 6 Triorchidism is the numeric alteration most frequently found, as well as left laterality (60%) and the scrotal location (70%). Our case, though its scrotal location, is right sided. However, several locations have been described at any point along the way of embryological testicular descent to its final scrotal location. According to the literature, patient age at diagnosis ranges from 15 to 25 years, with a mean age of 17 years in the study including the largest series reported. 3 Diagnosing this malformation in childhood or in individuals over 50 is even more infrequent. The clinical signs and symptoms consist of scrotal pain, which may be intermittent and associated or not to palpation of scrotal tumor, as in the case we report. 1 Many patients have never experienced clinical symptoms, and the diagnosis might be incidental. 7 Imaging studies are essential for reaching the diagnosis. SU would disclose the supernumerary testes. However, it might be necessary to perform techniques such as MRI, which could provide diagnostic confirmation. 8 Some papers report that MRI does not provide additional information and recommend it should be kept for cases where intra-abdominal polyorchidism or malignancy is suspected. 3 On the contrary, other studies recommend that a pelvic MRI should be mandatory after SU. In our case, MRI was helpful for confirmation of the anatomy. Hormone determination of β-hCG, AFP and LDH could be requested in case of doubt of testicular cancer. Among all of these, Dear Editor, Polyorchidism refers to the presence of more than two testicles. Blasius described it for the first time in 1670 as …