Rare instance of tri-orchidism detailed in medical report
In an unusual finding, a 29-year-old man was recently diagnosed with triorchidism, a rare congenital anomaly of the urogenital tract. The case was reported in a clinical examination and confirmed through sonographic investigations.
The first recorded case of triorchidism was reported in 1670 by Blasius during an autopsy. Since then, less than 200 cases have been reported in literature, making this condition extremely rare. The most common form of polyorchidism, a similar anomaly, is triorchidism, where three testes are found in the scrotal cavity.
In this particular case, the 29-year-old man presented with left hemiscrotal pain. Upon examination, he was found to have two small testicles with equal volume (6 cc and 5.8 cc) in the left hemiscrotum, along with an additional, larger testis on the right. This right testis was found to be larger than both testes in the left hemiscrotum.
The complementary MRI of the man revealed two round to oval shaped structures with signal characteristics identical to normal testicular tissue, confirming the presence of the extra testis. The extra testis was commonly found in the scrotum (66%), inguinal canal (23%), or retroperitoneum (9%) in cases of triorchidism.
The man in the case report did not show any evidence of hydrocele, varicocele, or any other pathology on sonography. He also did not have testicular torsion or varicocele at the time of diagnosis. Moreover, he did not have maldescent, inguinal hernia, malignancy, or infertility at the time of diagnosis.
The management of patients with triorchidism is controversial and depends on multiple factors, including the location of the testis, the reproductive potential, size of the testis, and age of the patient. In this case, the man was managed conservatively due to his age and need to maintain fertility. He was advised for routine follow-up with instructions to report any changes in size, shape, or pain.
The exact cause of triorchidism is not known, but some suggest that it may be due to early embryogenesis and the development of peritoneal bands. The author who first reported the case of triorchidism was A. Ahlfeld in the year 1880. Orchidectomy is recommended in suspected cases of malignancy.
This case report sheds light on a rare condition that, despite its infrequency, is an important topic for medical professionals to be aware of. The man in the case report has been advised to undergo regular follow-ups to monitor any changes in his condition.
