Incidental Finding of Ectopic Adrenal Cortical Tissue During Orchidectomy for Intra-abdominal Cryptorchidism in a Nine-Year-Old Boy

Ectopic adrenal tissue is a rare developmental anomaly resulting from aberrant migration of primordial adrenal cells during embryogenesis and is usually asymptomatic, being most often detected incidentally during surgical procedures performed for other conditions. We report the case of a nine-year-old boy who underwent laparoscopic exploration for a non-palpable left testis. Due to the high intra-abdominal position and marked atrophy of the testis, an orchidectomy was performed. Gross examination revealed no significant abnormalities. Histological analysis showed atrophic seminiferous tubules along with a well-circumscribed focus composed of non-atypical adrenal cortical cells without a medullary component. Immunohistochemical staining was positive for Melan-A and inhibin, while calretinin showed only weak positivity, strongly supporting adrenal cortical differentiation and arguing against Leydig cell hyperplasia. Staining for neuroendocrine markers (chromogranin and neuron-specific enolase (NSE)) was negative, confirming the absence of adrenal medullary tissue. The postoperative course was uneventful, and routine follow-up was scheduled. This rare incidental finding highlights the importance of systematic histopathological examination of orchidectomy specimens. Although typically benign, the identification of ectopic adrenal tissue is essential for understanding developmental anomalies and avoiding potential diagnostic pitfalls.