True hermaphroditism with ovotestis

Sivasamy Manohar, MD., DMRD


Case report

This is a case of a 18-year-old man who was referred to our department for gynecomastia. Clinical examination showed very well developed female-like breasts on both sides. He had typical male facial hair growth.

The genitalia showed micropenis and small scrotum resembling labia. On palpation, the left testicle seemed larger than the right one and slightly nodular. The right testicle was located almost in the perineal region. His penis was small and had hypospadia. Patient reported that he underwent some kind of surgery to modify the external urethral opening.

The ultrasound examination revealed that the left part of the scrotum contains both testicle and ovary, so called ovotestis.

The ovarian component was located in the upper part of the scrotum, above the testicle. Ovarian tissue had follicles and the testicle contained microcalcifications. The right part of the scrotum showed only a small testicle with microcalcifications.

There was no uterus or ovaries detected in the abdominal cavity. The prostate contained large teardrop-shaped cyst. We detected only the left seminal vesicle, the right one was not seen.

Images 1,2: Images of the left scrotum. Ovary is on the left side, note follicles, testis is on the right with microcalcifications.


Images 3,4
: Image 3 shows the left ovotestis, note the microcalcifications of the testis. Image 4 shows transverse view of the inferior part of the scrotum, note both testicles. 


Image 5,6: Image 5 shows the large follicle of the ovary which is located in the superior part of the left scrotum. Image 6 shows left seminal vesicle.


Images 7,8: Images show teardrop-shaped prostatic cyst.


Images 9,10: Image 9 shows gynecomastia. Image 10 shows ambiguous genitalia with micropenis and small scrotum.


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