William Munna, Bhusal Amrit, Ahmad Waqar, Anjum Abdul Sattar, Qadeer Usman
Department of Diagnostic Radiology and Imaging, Nishtar Medical University.
Department of Radio-diagnostics and Imaging, BP Koirala Institute of Health Sciences (BPKIHS), Dharan, Sunsari, Nepal.
Ann Med Surg (Lond). 2024 Aug 30;86(10):6257-6260. doi: 10.1097/MS9.0000000000002510. eCollection 2024 Oct.
Poly-orchidism is a rare congenital anomaly of the genitourinary system, which is characterized by the presence of more than two testicles, also being termed as "supernumerary testis". Tri-orchidism is the most frequently encountered form of poly-orchidism, which is defined as the presence of more than two intra- or extra-scrotal testicles.
The authors present a case of a 16-year-old male who presented with a complaint of an empty left scrotal sac, and was later diagnosed as a case of tri-orchidism with each testis in bilateral hemipelvis confirmed by ultrasound with Doppler and MRI. The patient was kept in regular follow-up for 6 months with radiological assessment, which showed no changes in radiological findings as before.
The majority of patients are asymptomatic or present with a painless inguinal or scrotal mass, undescended testis, and rarely torsion of the supernumerary testis. Imaging modalities like US, Doppler study, and MRI are required for the diagnosis. Non-scrotal location of poly-orchidism is considered as the most important risk factor for malignancy. The surgical approach is required for any malignant changes in biopsy, US showing features of malignancy, absent spermatogenesis or in cases where regular follow-up is not possible. Otherwise, a conservative approach with regular follow-up is enough if above indications are absent.
The complications of poly-orchidism like undescended testes, inguinal hernia, infertility, and possibly malignancy must be borne in mind while diagnosing poly-orchidism. The above-mentioned aspects must also be considered while choosing surgical intervention versus a conservative approach with follow-up, depending upon the position of the supernumerary testicle being scrotal or ectopic.
多睾症是一种罕见的泌尿生殖系统先天性异常，其特征为睾丸多于两个，也被称为“额外睾丸”。三睾症是多睾症最常见的形式，定义为阴囊内或阴囊外存在多于两个睾丸。
作者报告一例16岁男性患者，主诉左侧阴囊空虚，随后经超声多普勒检查和磁共振成像（MRI）确诊为三睾症，双侧半骨盆各有一个睾丸。对该患者进行了6个月的定期随访及影像学评估，结果显示影像学表现与之前无变化。
大多数患者无症状，或表现为无痛性腹股沟或阴囊肿块、隐睾，额外睾丸扭转则较为罕见。诊断需要超声、多普勒检查及MRI等影像学手段。多睾症位于阴囊外被认为是发生恶性肿瘤的最重要危险因素。活检出现任何恶性变化、超声显示恶性特征、无精子生成或无法进行定期随访时，均需要采取手术治疗。否则，若不存在上述指征，采取定期随访的保守治疗方法即可。
诊断多睾症时必须牢记其并发症，如隐睾、腹股沟疝、不育以及可能的恶性肿瘤。在选择手术干预还是随访保守治疗时，也必须考虑上述方面，这取决于额外睾丸是位于阴囊内还是异位。
