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DOI: 10.1148/rg.242035171
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RadioGraphics 2004;24:417

Letter to the Editor

Splenogonadal Fusion: A Rare Extratesticular Scrotal Mass

Giorgio Pomara, MD

1 Section of Urology, Department of Surgery, S. Chiara Hospital, Pisa University, Via Roma 67, Pisa 56122, Italy. e-mail: g.pomara@libero.it

Editor:

We read with great interest the article in the January 2003 issue of RadioGraphics by Woodward et al (1), who reviewed the radiologic and pathologic findings and their correlation in extratesticular scrotal masses. We are grateful to RadioGraphics for publishing this review, since we consider the information extremely helpful in clinical practice. In particular, concerning "paratesticular masses," the authors carefully discuss hernias, calculi, fibrous pseudotumors, and supernumerary testes.

Unfortunately, they did not report another rare congenital anomaly that, in our opinion, should be included in the differential diagnosis of scrotal masses: splenogonadal fusion. We would therefore like to present our case of a 27-year-old man referred to our institution for sonographic evaluation of a palpable, mobile, and painless left scrotal mass. Sonography showed a homogeneous, well-encapsulated left extratesticular mass with the same echogenicity as that of the normal testis (Figure). The patient underwent exploratory surgery and the mass was removed. The postoperative diagnosis was "ectopic splenic tissue" arising from a splenogonadal fusion.



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  		Figure. Sonogram of the left side of the scrotum shows a homogeneous, well-encapsulated extratesticular mass with the same echogenicity as that of the normal testis.

 
Splenogonadal fusion is a rare congenital malformation that was first described in 1889 (2), and about 150 cases have been reported in the English literature (3). Splenogonadal fusion results from abnormal connection of splenic tissue with gonadal-mesonephric structures. Putschar and Manion (4) classified splenogonadal fusion into two types: continuous (direct connection between the spleen and gonad) and discontinuous (no anatomic connection between ectopic splenic tissue and the principal spleen).

Typically, the malformation manifests as a testicular mass, and the diagnosis is seldom made preoperatively. A definitive diagnosis cannot be made solely on the basis of sonographic findings. Some authors have described the use of technetium-99m sulfur colloid scintigraphy to identify ectopic splenic areas of activity, thereby adding information to the imaging diagnosis (5). However, surgical exploration is generally required to rule out malignancy. Nevertheless, orchiectomy can be avoided because splenic tissue can be dissected away from the tunica albuginea, as was done in our patient. Unfortunately, 37% of the reported cases are associated with unnecessary orchiectomy (6).

In conclusion, Woodward and colleagues should be congratulated for highlighting several important issues regarding extratesticular scrotal masses. We hope that our observation also can be useful.

References

  1. Woodward PJ, Schwab CM, Sesterhenn IA. Extratesticular scrotal masses: radiologic-pathologic correlation. RadioGraphics 2003; 23:215-240.[Abstract/Free Full Text]
  2. Pommer G. Verwachsung des linken kryptorchischen Hodens und Nebenhodens mit der Milz in einer Mib-geburt mit zahlreichen Bildungsdefekten. Ber Naturw Med Ver Innsbruck 1888–1889; 17–19:144.
  3. Imperial SL, Sidhu JS. Nonseminomatous germ cell tumor arising in splenogonadal fusion: a case report and review of the literature. Arch Pathol Lab Med 2002; 126:1222-1225.[Medline]
  4. Putschar WG, Manion WC. Splenic-gonadal fusion. Am J Pathol 1956; 32:15-33.
  5. Guarin U, Dimitrieva Z, Ashley SJ. Splenogonadal fusion: a rare congenital anomaly demonstrated by 99Tc-sulfur colloid imaging—a case report. J Nucl Med 1975; 16:922-924.[Abstract/Free Full Text]
  6. Cirillo RL, Jr, Coley BD, Binkovitz LA, Jayanthi RV. Sonographic findings in splenogonadal fusion. Pediatr Radiol 1999; 29:73-75.[CrossRef][Medline]




This Article
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