This is an open access article under the terms of a license that permits non-commercial use, provided the original work is properly cited. © 2022 The Authors. Société Internationale d'Urologie Journal, published by the Société Internationale d'Urologie, Canada. Key Words Competing Interests Article Information Accessory spleen, testicular tumor, scrotal swelling, splenogonadal fusion None declared. Patient consent: Obtained. Received on April 22, 2022 Accepted on April 24, 2022 Soc Int Urol J. 2022;3(5):354–355 DOI: 10.48083/CTUZ3597 FIGURE 1. Large accessory scrotal spleen. MRI of the scrotum showed a large 8cm left scrotal mass (white arrow) (A). The testis could not be identified separately. Histologic images showed splenic tissue (B, C) adherent to the tunica albuginea but not enveloped by it (hematoxylin and eosin staining; 5x magnification in B, and 10x in C; blue arrows show white pulp; red arrow shows red pulp with sinusoids) and adjoining atrophic testicular tissue (D) with clusters of Leydig cells (red arrow) and atrophic seminiferous tubules (red arrow; hematoxylin and eosin staining; 10x) Large Accessory Scrotal Spleen Masquerading as Testicular Tumor Sirish Bharadwaj,1 Sanjay Sinha,1 Meenakshi Swain2 1 Department of Urology, Apollo Hospital, Hyderabad, India 2 Department of Pathology, Apollo Hospital, Hyderabad, India A 75-year-old male presented with left scrotal swelling of 1 year’s duration. The firm, non-tender swelling was indistinct from the testis and consistent with left testicular tumor. Serum alpha fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase levels were normal. Scrotal ultrasonography and MRI showed 8.4x5.0x4.0cm mass in the left scrotum without calcification or necrosis (Figure 1A). The left testis could not be identified separately. A possibility of spermatocytic seminoma or lymphoma was considered. Left high inguinal orchidectomy was performed with uneventful recovery. At histopathology, the entire mass was noted to be an accessory spleen with adjoining atrophic compressed testicular tissue (Figures 1B,C,D). 354 SIUJ • Volume 3, Number 5 • September 2022 SIUJ.ORG CLINICAL PICTURE https://orcid.org/ https://orcid.org/0000-0001-7090-2091 mailto:drsanjaysinha%40hotmail.com?subject=SIUJ https://orcid.org/0000-0002-2121-2518 http://SIUJ.org Accessory splenic tissue is a common finding noted in 2% to 35% of individuals most often in and around the splenic hilum[1]. It can be classified as continuous or discontinuous with the spleen[2]. Accessory splenic tissue presenting as a scrotal mass is very rare[1]. Splenic tissue reaches the scrotum as a result of spleno-gonadal fusion, typically on the left side with tissue enveloped or adherent to the tunica albuginea[3]. This case is unusual because of the age of presentation, relatively short history, and large size of the mass. Most men present as young adults[2,3]. Surgery is unnecessary if the diagnosis can be made preoperatively[4]. Making a preoperative diagnosis to avoid surgery is practically difficult unless the patient can categorically state that the mass has been present and stable for years. In such a setting, Doppler imaging showing a hyper-vascular upper polar mass[1] confirmed by splenic scintigraphy using technitium-Tc99m[2] may help avoid surgery. Intraoperative frozen section histology might help avoid orchidectomy if exploration is deemed unavoidable[3,4]. The short history in our patient is difficult to explain. Patients with splenic disease such as leukemia or malaria may show concurrent increase in size of the acces- sory spleen[2]. However, our patient did not show any such disease. References 1. Marwah N, Bhutani N, Kalra R, Kajal P. Accessory spleen within the scrotum. J Pediatr Surg Case Rep.2019 Mar 1;42:19-23. 2. Kadouri Y, Carnicelli D, Sayegh HE, Benslimane L, Nouini Y. Pathogenesis, diagnosis, and management of splenogonadal fusion: a literature review. Case Rep Urol.2020 Oct 7;2020:8876219. 3. Huang G, Huang Y, Zeng L, Yuan M, Wu Y, Huang L. Continuous- type splenogonadal fusion: a case report. Exp Ther Med.2017 May;13(5):2019-2021. 4. Abokrecha A, Almatrfi A. Discontinued splenogonadal fusion and bilateral empty scrotum in an 18-month-old boy. European J Pediatr Surg Rep.2017 Feb;5(1):e1-e3. 355SIUJ.ORG SIUJ • Volume 3, Number 5 • September 2022 Large Accessory Scrotal Spleen Masquerading as Testicular Tumor http://SIUJ.org