Abdomen / Pelvis for Thursday, April 10th, 2025

History

14 year-old male with a hyperenhancing left scrotal lesion incidentally noted on a CT abdomen pelvis performed for umbilical hernia

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Question

This paratesticular lesion was an incidental finding on ultrasound. Histology confirmed benign ectopic tissue. What is the diagnosis?

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Correct answer

Splenogonadal fusion

Discussion

Splenogonadal fusion is a rare congenital condition where there is an abnormal connection between the spleen and the gonad. It occurs during early gestation (weeks 5–8) when the spleen and gonadal tissue are in close proximity. Continuous and discontinuous variants have been described. The discontinuous variant, as in this case, lacks a direct connection to the spleen. Most cases occur in males, often presenting as a testicular mass or cryptorchidism, typically on the left. Diagnosis is often confirmed histologically after resection, to exclude tumors.

Differential diagnosis

Adenomatoid tumor

Fibrous pseudotumor

Rhabdomyosarcoma 

Plyorchidism

References

• Chu J, Mokkarala M, Zhang M, Dixe de Oliveira Santo I, Lanier MH. Splenogonadal Fusion. Radiographics. 2024;44(4):e230224. doi:10.1148/rg.230224
• Kadouri Y, Carnicelli D, Sayegh HE, Benslimane L, Nouini Y. Pathogenesis, Diagnosis, and Management of Splenogonadal Fusion: A Literature Review. Case Rep Urol. 2020;2020:8876219. Published 2020 Oct 7. doi:10.1155/2020/8876219