[The problem of extirpation of gonads in "testicular feminisation"]

The 15-year old female patient G. G. was referred to the outpatient department for child gynaecology on account of a primary amenorrhoea. The endocrinal parameters found (testosterone, oestradiol, 17 OHCS, 17 KS), chromosome analysis, vaginoscopy and the result of a laparoscopy led to the clinical diagnosis of "testicular feminisation". Satisfactory development of secondary female sex characteristics and sudden increase of complaints caused by an inguinal hernia on the left (gonad situated in the inner inguinal ring) prompted us to perform bilateral extirpation of gonads with simultaneous treatment of the inguinal hernia. Histological examination revealed the existence of a seminoma of the right gonad. This case confirm our stand in respect of extirpation of gonads at the onset of puberty, but it also raised the question as to whether it would be advisable to operate at an even earlier stage in order to avoid the risk of malignant degeneration of intra-abdominally positioned testes.