Unusual presentation of perineal ectopic testis in adulthood leading to orchiectomy: a case report and review of literature

Introduction and importance: Ectopic testis is a rare congenital condition where the testicles are located outside the normal scrotal area. Only about 1% of ectopic testes are found in the perineal region. Case presentation: A 21-year-old male from Debre Tabor, Ethiopia, presented with a right-sided perineal swelling since childhood and associated pain in the same area for 6 months prior to presentation. Physical examination was unremarkable, except for the genitourinary examination, which revealed an underdeveloped right scrotum with no palpable testis. A 3 cm × 4 cm soft, non-tender, mobile mass was palpated in the right perineal area. The left scrotal testis was normal. Diagnostic perineal ultrasound showed an atrophied ectopic right testicle in the perineal area, with a normal left scrotal testis. Consequently, a right orchiectomy with left-sided testicular fixation was performed. The surgery was uneventful. Clinical discussion: Perineal ectopic testis is a rare congenital anomaly. Testicular development and descent is a complex, multi-stage process influenced by mechanical and hormonal factors. Cryptorchidism refers to the testis descending outside the scrotum, but remaining within the normal pathway. In contrast, descent outside the normal pathway is defined as ectopic testis. Ectopic testes can be found in various locations, the superficial inguinal pouch being the most common and rarely in perineal area. Surgical management depends on the condition of the ectopic testis. Conclusion: Perineal ectopic testis, though rare, should remain in the differential diagnosis for any perineal mass. Early diagnosis and prompt management are paramount to prevent potential complications such as testicular atrophy.