PMC5295633_01
Computed Tomography (CT) scan findings.. A. The hernia sac extends to the subcutaneous layer on the external oblique aponeurosis, and contained a round mass (arrow).. B. The hernia protrudes from the lateral side of the right epigastric vessels (arrow).. C. The round cystic mass is positioned superiorly in the hernia sac (arrow).. D. The hernia orifice is seen at the right internal inguinal ring (arrow).
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The hernia sac contained a round mass, thought to be an ectopic testis (Fig. 1).
Laparoscopic findings.. A. The mesentery of the small intestine is adherent (arrow) to the hernia orifice.. B. There is no hernia in the left internal inguinal ring (arrow).. C. After dissection of the adhesions, a large hernia orifice was found lateral to the right inferior epigastric vessels (arrow).. D. After hernia repair, the peritoneum was sutured next to the right epigastric vessels (black arrow) following resection of the hernia sac. The hernia orifice was closed (white arrow) with a Kugel patch which was laid onto the pre-peritoneal space.
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Adhesions from the mesentery of the small intestine to the area alongside the internal inguinal ring were seen (Fig. 2A). There was no hernia at the left internal inguinal ring (Fig. 2B), and the left testis was not seen in the abdominal cavity. A 5 mm port was inserted in the right lower quadrant and adhesions around the right inferior epigastric vessels were divided (Fig. 2C).
The ectopic testis.. A. The ectopic testis was found inside of the cystic lesion in the distal portion of the hernia sac.. B. The spermatic cord is connected to the atrophied testis.
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The ectopic testis was found inside the cystic lesion (likely a hydrocele) in the distal portion of the hernia sac (Fig. 3A), with attached spermatic cord. The ectopic testis was atrophied (Fig. 3B), and resected with the hernia sac after ligation of the spermatic cord.
Pathological findings.. A. Atrophic and hyalinized seminiferous tubules with thickened basement membranes are seen, without germ cells (x40).. B. Hypertrophy of Leydig cells (x10).. C. The lesion has small, round nucleoli with clear vacuolated polygonal cytoplasm, diagnosed as a Leydig cell tumor (x10).. D. Clear, vacuolated cytoplasm is caused by abundant intracytoplasmic lipid, and reminiscent of that seen in tumors of the adrenal cortex (x20).
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Pathologic findings revealed atrophic and hyalinized seminiferous tubules with a thickened basement membrane (Fig. 4A). Germ cells were completely deficient, and Leydig cells were prominent and hypertrophied (Fig. 4B). In other areas, large, polygonal cells with round nuclei and clear cytoplasm were seen, diagnosed as a Leydig cell tumor (Fig. 4C, D).