Incidental ectopic adrenal tissue found in undescended testis during inguinal hernia repair

Abstract

The following is a case report about a 63 year old man that underwent hernia repair surgery, whose missing testicle, that contained ectopic adrenal tissue, was incidentally found during the procedure.

A 63-year-old man with no history of illness presents to the hospital with a missing right testicle. Ultrasonography finds right inguinal hernia and right undescended testis. The patient underwent single-side inguinal orchiectomy and inguinal hernia with graft repair.

After the orchiectomy, the pathology report showed a material weighing 31.1g, containing a 5.5x2cm spermatic cord and epididymis. A 3.5x2cm off-white, yellow-orange testicle was observed, and inside the paratesticular adipose tissue, a 0.5x0.9cm in diameter orange nodule was found. Under microscopy, there was ectopic adrenal cortical tissue (0.5-0.9cm in the paratesticular region), total tubular sclerosis and testicular atrophy, and orchiectomy material. The sections were examined by staining with H&E and PAS histochemistry stains (Figure a and b).

An anomaly during embryologic development may cause the appearance of ectopic adrenal tissue along the path of the testis. While most cases go unnoticed, groin surgery can incidentally reveal the ectopic tissue. While cases of ectopic adrenal tissue are rarely seen in adults, the literature shows that when it actually is found, it is mostly incidental. As such, it’s better for the practitioner to acknowledge it, and prepare for an unexpected discovery.