PMC2817392_01
Case 1: pelvic ultrasound pre- and post-FSH; left gonad pre-FSH: 0.6 cm x 0.4 cm x 0.4 cm  =  0.05 cc; left gonad post-FSH: 0.8 cm x 0.5 cm x 0.6 cm  =  0.1 cc; right gonad pre-FSH: 2.4 cm x 1.3 cm x 1.6 cm  =  2.61 cc; right gonad post-FSH: 1.9 cm x 0.9 cm x 1.2 cm x 1.07 cc (normal ovarian volume for age: 1.05 cc, SD 0.67, normal testicular volume <=1  cc).
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fig1
The post-FSH ultrasound revealed numerous gonadal cystic structures, with more on the left gonad than on the right, suggesting these gonads represented ovotestes (Figure 1).
Histopathologic features from the bilateral gonadal excisions (representative images from Case 3) demonstrated features of ovotestes (a)-(c) with ovarian stroma and primary and primordial follicles (b) in close proximity to seminiferous tubules with testicular stroma (c). Cases 1 and 2 demonstrated similar histopathologic findings, with the gonadal biopsies submitted for microscopic examination. (hematoxylin and eosin staining, original magnification: (a) 200x, (b) and (c) 400x).
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fig2
Upon histopathologic examination, the bilateral gonadal biopsies revealed both ovarian and testicular tissue similar to that illustrated in Figure 2 (representative images from Case 3), confirming the presence of an ovotestis. Histopathologic examination of the bilateral gonadal biopsies and excisions demonstrated features of ovotestes, as illustrated in Figure 2 (representative images from Case 3). The ovarian tissue contained typical stroma with relatively frequent primary and primordial follicles (Figure 2(b)).
Case 2: Pelvic ultrasound pre- and post-FSH. Left gonad pre-FSH: 1.0 cm x 0.6 cm x 0.6 cm  =  0.19 cc. Left gonad post-FSH: 1.8 cm x 1.1 (3rd dimension not measured). Right gonad pre-FSH: 0.9 cm x 0.6 cm x 0.8 cm  =  0.23 cc. Right gonad post-FSH: 0.9 cm x 1.3 cm x 0.9 cm  =  0.55 cc (normal ovarian volume for age  =  1.06 cc, SD 0.96, normal testicular volume <=1  cc).
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fig3
Bilateral inguinal hernias with apparent gonads in the hernia sacs also were seen (Figure 3). The post-FSH ultrasound demonstrated a new single cyst in the left gonad (Figure 3). Upon histopathologic examination, the bilateral gonadal biopsies revealed both ovarian and testicular tissue similar to that illustrated in Figure 2 (representative images from Case 3), confirming the presence of an ovotestis. Histopathologic examination of the bilateral gonadal biopsies and excisions demonstrated features of ovotestes, as illustrated in Figure 2 (representative images from Case 3).
PMC2817392_02
Histopathologic features from the bilateral gonadal excisions (representative images from Case 3) demonstrated features of ovotestes (a)-(c) with ovarian stroma and primary and primordial follicles (b) in close proximity to seminiferous tubules with testicular stroma (c). Cases 1 and 2 demonstrated similar histopathologic findings, with the gonadal biopsies submitted for microscopic examination. (hematoxylin and eosin staining, original magnification: (a) 200x, (b) and (c) 400x).
IJPE2009-507964.002.jpg
PMC2817392_02_IJPE2009-507964.002.jpg
fig2
Upon histopathologic examination, the bilateral gonadal biopsies revealed both ovarian and testicular tissue similar to that illustrated in Figure 2 (representative images from Case 3), confirming the presence of an ovotestis. Histopathologic examination of the bilateral gonadal biopsies and excisions demonstrated features of ovotestes, as illustrated in Figure 2 (representative images from Case 3). The ovarian tissue contained typical stroma with relatively frequent primary and primordial follicles (Figure 2(b)).
Case 2: Pelvic ultrasound pre- and post-FSH. Left gonad pre-FSH: 1.0 cm x 0.6 cm x 0.6 cm  =  0.19 cc. Left gonad post-FSH: 1.8 cm x 1.1 (3rd dimension not measured). Right gonad pre-FSH: 0.9 cm x 0.6 cm x 0.8 cm  =  0.23 cc. Right gonad post-FSH: 0.9 cm x 1.3 cm x 0.9 cm  =  0.55 cc (normal ovarian volume for age  =  1.06 cc, SD 0.96, normal testicular volume <=1  cc).
IJPE2009-507964.003.jpg
PMC2817392_02_IJPE2009-507964.003.jpg
fig3
Bilateral inguinal hernias with apparent gonads in the hernia sacs also were seen (Figure 3). The post-FSH ultrasound demonstrated a new single cyst in the left gonad (Figure 3). Upon histopathologic examination, the bilateral gonadal biopsies revealed both ovarian and testicular tissue similar to that illustrated in Figure 2 (representative images from Case 3), confirming the presence of an ovotestis. Histopathologic examination of the bilateral gonadal biopsies and excisions demonstrated features of ovotestes, as illustrated in Figure 2 (representative images from Case 3).
Case 3: Pelvic ultrasound pre- and post-FSH. Left gonad pre-FSH: 1.2 cm x 0.6 cm x 0.8 cm  =  0.3 cc. Left gonad post-FSH: 1.3 cm x 0.5 (third dimension not measured). Right gonad pre-FSH: 0.7 cm x 0.7 cm x 0.5 cm  =  0.13 cc. Right gonad post-FSH: 0.8 cm x 0.5 cm x 0.8 cm  =  0.17 cc (normal ovarian volume for age  =  1.06 cc, SD 0.96, normal testicular volume <=1  cc)
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fig4
The post-FSH ultrasound was unchanged (Figure 4).