Four Cases of Adrenal Rest Incidentally Detected During Orchiopexy

Abstract

Testicular micronodules are detected incidentally during scrotal and inguinal surgeries in boys. We encountered four cases of male patients with testicular micronodules ranging from 11 months to 5 years of age. During orchiopexy for undescended or retractile testes, fat-like micronodules measuring 1–3 mm in size were discovered in the spermatic cord or outside the tunica vaginalis near the testis. Although micronodules can be easily removed, making a pathological diagnosis is difficult. On the basis of immunostaining results, adrenal rest was diagnosed. The pathogenesis of adrenal rest is thought to be caused by the abnormal differentiation of the adrenal glands from the adreno-genital primordium during the fetal period and abnormal positioning during the developmental process associated with the descent of the testis. Although this is an asymptomatic condition that often regresses spontaneously, the possibility that it may induce hyperplastic changes or endocrine symptoms in the future cannot be ruled out. Because it is difficult to make a macroscopic diagnosis during surgery, the excised tissue should be evaluated as soon as possible. Performing histological examinations, including an immunohistochemical analysis, is therefore essential to establish an accurate diagnosis.