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Urology Case Reports
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Splenogonadal fusion: A rare ﬁnding during routine orchiopexy
Catherine J. Chen
, Nicholas Kavoussi
, Micah A. Jacobs
University of Texas Southwestern, Department of Urology, United States
Vanderbilt University, Department of Urology, United States
Splenogonadal fusion remains a rare congenital anomaly, with limited reports in the literature. It is important to
be aware of this benign condition as orchiectomy can result from confusion with malignant processes. We
present a case of splenogonadal fusion in a 12-month-old healthy male with history of cryptorchidism found at
the time of surgery.
Splenogonadal fusion (SGF) is a rare congenital anomaly, resulting
in the fusion between spleen and gonad. It was ﬁrst reported in lit-
erature in 1883 by Bostroem with approximately 150 cases reported in
literature since then.
SGF can present as an isolated ﬁnding or in
association with limb defects, micrognathia, anal atresia and other
Awareness of this anomality is important as
almost 37% of cases reported in literature is associated with un-
A 12-month-old healthy male patient was referred for evaluation of
left cryptorchidism. On physical exam, he was noted to have normal
descended right testicle and a palpable mass in the left groin presumed
to be his left testicle. He was subsequently taken to the operating room
for a left orchiopexy.
The orchiopexy began through a scrotal approach. The testis was
delivered through the scrotal incision, at which time an adherent
splenule was also delivered (Fig. 1). The splenic tissue, which was ap-
proximately 2 cm × 3 cm and contained a tail extending into the ret-
roperitoneal space, was carefully dissected free from the testicle and
cord structures and released into the retroperitoneum through a sub-
sequent inguinal incision (Fig. 2). A left hernia sac was also identiﬁed,
divided and ligated. Once freed from the splenic tissue, the testicle
easily reached the dependent scrotum and was secured with monocryl
suture. 6 weeks post-operatively follow-up revealed the left testicle well
positioned in the scrotum with no hernias or masses in the groin.
Although SGF is more commonly reported males with a male:female
ratio of 15:1, this discrepancy is likely due to under diagnosis in females
due to the intraabdominal location of the gonad.
While the exact pa-
thophysiology of the fusion is unclear, it is thought that the fusion
between the spleen and gonad occurs between the 5th and 8th week of
gestation, prior testicular descent.
There are two forms of SGF, continuous and discontinuous. In the
continuous form, there is a structural attachment between the spleen
and gonad. This structural attachment can range from a cord-like ﬁ-
brous structure, to completely splenic or beaded with multiple splenic
In the discontinuous form, accessory splenic tissue is fused to
the gonad and there is no attachment to the orthotopic spleen. Slightly
more than half of the cases (55%) reported in literature were cases of
In both forms, the fused splenic mass is most com-
monly fused to the testicle, though they can also be fused to the epi-
didymis or spermatic cord.
The splenic tissue is usually encapsulated
by its own capsule, allowing for it to be separated from the testicle;
however, there has been 1 reported case of intermingling of splenic and
Histological evaluation of the fused splenic tissue is
The continuous form of SGF is more commonly associated with
other congenital anomalies, including cryptorchidism, limb defects,
cardiac defects, micrognathia, cleft palate, anal atresia, and spina bi-
Of these malformations, limb defects are most common and is
termed splenogonadal fusion-limb defect syndrome.
Splenogonadal fusion is a rare benign entity that is important to
Received 2 April 2019; Received in revised form 29 April 2019; Accepted 6 May 2019
Corresponding author. 2350 Stemmons Freeway, 4th Floor, F4.04, Dallas, TX, 75207, United States.
E-mail address: firstname.lastname@example.org (C.J. Chen).
Urology Case Reports 27 (2019) 100904
Available online 07 May 2019
2214-4420/ © 2019 The Authors. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license
recognize as it can lead to unnecessary orchiectomy. The accessory
splenic tissue can be easily separated from the testicular tissue and cord
structures, thus allowing the undescended testicle to be brought down
into the scrotum.
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Fig. 1. Accessory splenule attached to the spermatic cord.
Fig. 2. Accessory splenule freed from the spermatic cord.
C.J. Chen, et al. Urology Case Reports 27 (2019) 100904