PMC8052911_01
External genitalia showing empty right hemiscrotum with meatal opening at penoscrotal junction (arrow mark pointing the urinary meatus)
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F1
External genitalia revealed penoscrotal hypospadias and absent testis on the right side of the scrotum [Figure 1].
(a-c) Contrast-enhanced computed tomography abdomen and pelvis showing large complex cyst in the left side of the pelvis and rectovesical space
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F2
Contrast-enhanced computed tomography showed complex cysts in the pelvis and rectovesical space of size 12.5 cm x 7.5 cm x 6.5 cm and 12 cm x 6 cm x 5.5 cm, respectively, and both the kidneys appeared normal [Figure 2].
(a) Intraoperative picture showing dense adhesion between cyst, bladder, and left spermatic cord. (b) Resected specimen (cystic structure resembling uterus, cervix with cord structure, and left testis)
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F3
Furthermore, the left spermatic cord was adherent to the cystic structure, and hence, the left testis has to be sacrificed along with excision of the cystic structure [Figure 3].
(a) Excised gross specimen. (b) Histopathology showing poorly formed areas of endometrial glands and stroma. (c) Histopathology showing foci of the cervix. (d) Histopathology showing seminiferous tubules with spermatocytes and spermatogonia
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F4
Histopathological examination revealed features of Mullerian remnants (endometrial glands and cervix) in the cystic structure removed [Figure 4].