978 Simultaneous Orchidectomy, Hernia Repair, and the Discovery of Gonadoblastoma-Like Features in an Undescended Testis – A Rare Case Report

Introduction Undescended testes, a congenital anomaly, present unique challenges when associated with clinical manifestations. Case Report 38 years old patient, with no known co-morbidities, exhibited a two-year history of a stable lump in the right inguinal region. He had no history of tuberculosis exposure, no lower urinary tract symptoms or impotence but had history of primary subfertility. Clinical examination of the contralateral side showed no abnormalities. Diagnostic Assessment - Surgical exploration entailed orchidectomy and exposed unexpected gonadoblastoma-like features in the undescended testis. Contralateral testis evaluation yielded normal LDH, AFP, and Beta hCG levels. Therapeutic Intervention - Simultaneous exploration of the right inguinal region and orchidectomy aimed to address the undescended testis and revealed unexpected histopathological findings. Histopathological Analysis - Microscopic examination of the undescended testis specimen demonstrated small-sized seminiferous tubules with a thick basement membrane. The tubules were lined by Sertoli cells, yet spermatogenesis was notably absent. Clusters of Leydig cells and foci of rounded nests composed of germ cells and small sex cord cells were observed.These findings collectively indicated gonadoblastoma-like features. Importantly, there was no evidence of germ cell neoplasia in situ or malignancy. Discussion The unexpected histopathological findings introduce complexities to the case, raising questions about the nature of gonadoblastoma-like features in the context of undescended testes. The absence of malignancy prompts consideration of long-term implications for fertility management. Conclusions This case report illuminates the challenges associated with undescended testes and introduces unexpected histopathological findings. The discovery of gonadoblastoma-like features during surgical exploration emphasizes the necessity for meticulous clinical evaluation and long-term surveillance in managing such cases.