The spectrum of persistence of testicular blastema and ectopic testicular parenchyma: A possible result of focal delay in gonadal development

Sex-cord formation and organization are important steps in testicular development and depend on adequate interactions between mesenchymal cells, pre-Sertoli cells, and germ cells. These elements form the testicular blastema, the precursor of the testicular parenchyma, morphologically characterized by poorly organized sex cords and mesenchymal components. Here, we study two uncommon testicular lesions, unrelated to other gonadal anomalies. In the first group, we describe the features of persistence of testicular blastema in three fetal autopsy cases, discussing its possible pathogenesis and clinical importance. In the second, we analyze 11 cases of ectopic testicular parenchyma in the tunica albuginea, an uncommon benign condition of uncertain clinical significance, whose main differential diagnosis is gonadal dysgenesis. Based on their similar topography within the testis, and on their possibly shared embryological origin, we propose that both lesions may represent the two extremes of a maldevelopmental spectrum resulting from a focal delay in testicular development.