A 14-year-old male patient, resident of the city of Medellín, previously asymptomatic, was referred to the urology department of the Hospital Pablo Tobón Uribe with a diagnosis of a left testicular mass. The patient incidentally palpated a painless testicular mass in the left scrotal area, without noting its growth over time, unrelated to local trauma or associated with other symptoms. He initially consulted his local doctor and an ultrasound study was ordered, which showed two rounded, well-defined images of similar size, shape and echogenicity in the left scrotal sac, measuring an average of 9 x 11 mm, which also showed a similar Doppler pattern. This study ruled out lesions in the epididymis. With this result, they suggested ruling out a testicular mass or supernumerary testicle and referred him to the internist, who ordered a magnetic resonance imaging (MRI), which reported the presence of three well-defined oval-shaped structures in the scrotal sac, compatible with two testicles and one additional one (see Fig. 2), without masses or adenopathies. Because of these findings he was referred to urology. The patient had a negative personal history. On physical examination, the patient was found to be in good general condition, with vital signs within normal parameters for his age and with adequate development of the upper abdomen; there were no palpable masses or hernias in the abdomen and no inguinal lymphadenopathies. In the external genitalia, the penis was normal, and two healthy testicles were palpated, as well as a spherical adenomatous mass, located in the upper (proximal) area of the left hemiscrotal, mobile, non-painful, easily detachable with the fingers, with no nodulations or signs of local inflammation.

Based on the clinical history, complementary studies and physical examination findings, a diagnostic impression of paratesticular mass or PQ is made. With this clinical approach and prior review of the subject, it is decided to perform surgery for exploration and resection of the lesion, with the prior informed consent of the patient and his family. Under general anaesthesia, a transverse scrotal incision was made, with subsequent dissection by planes up to the albuginea on the left side, observing the presence of two structures of equal size, appearance and consistency compatible with testicles, being joined by a common epididymis and each with a vascular bundle, where only one, this led us to think that it corresponded in its embryological origin to the superior testicular pole, while the other, located proximally or superiorly, had a very dilated and unique venous bundle. The latter was sectioned, ligated with exhaustive haemostasis and cut; a rounded carmelite-coloured structure of firm consistency, approximately 1.2 cm in its largest diameter, was obtained and sent for anatomopathological study. A pocket is then made in the subdarthrodial space where the healthy testicle is placed and fixed with Vicryl® 4-0 (Ethicon, Johnson & Johnson) absorbable organic suture material (polyglactin). A plane closure is performed and a left ilioinguinal nerve block is made on the left side. The patient was discharged immediately postoperatively and progressed satisfactorily, without complications. Two fragments were processed for the pathology report and histological sections showed a normal testicle. No seminal intratubular neoplasia.

