Intratesticular Leiomyoma Associated with Polyorchidism: A Rare Case Report

Polyorchidism is an exceptionally rare congenital urogenital anomaly characterized by the presence of three or more testes, whereas testicular leiomyomas are
uncommon benign tumors originating from smooth muscle cells and typically demonstrating slow growth. We report the case of a 74-year-old man with congenital
polyorchidism who presented with suspected testicular malignancy. The patient was admitted with a complaint of firmness in the left scrotum. Physical examination
revealed two normally palpable testes; however, a well-circumscribed, firm mass measuring approximately 3–4 cm in diameter was detected distal to the left inguinal
canal. Serum tumor markers were within normal limits. Left inguinal exploration performed under spinal anesthesia demonstrated a normal left testis as well as a
separate mass originating from the testicular base and terminating in an additional spermatic cord structure, which was subsequently excised. Histopathological
examination confirmed the diagnosis of an intratesticular leiomyoma arising from a supernumerary testis containing a spermatic cord structure. Because intratesticular
leiomyomas are rare and may clinically mimic malignant testicular tumors, definitive diagnosis relies solely on histopathological evaluation, often leading to radical
orchiectomy in suspected cases. Polyorchidism has been reported in only a limited number of cases in the literature, and to the best of our knowledge, no tumor
arising from a third testis has previously been described.