Management of testicular Leydig cell tumor: A case report

Testis sparing surgery for Leydig cell tumor, surgical approach, and clinical outcome: A case report and review of literature

Testicular Leydig cell tumors are rare neoplasms of the testes. These tumors are generally benign but malignancy and metastatic potential have been described. Here, we present a case of Leydig cell tumor in a 49-year-old male, incidentally discovered as a testicular mass. The patient had no significant previous medical history. Ultrasonography revealed a hypoechoic, well-defined, vascularized lesion measuring 7 × 7 × 4 mm adjacent to the tunica albuginea. The patient underwent testis sparing surgery, employing a modified approach including intraoperative ultrasound-guided localization, en-bloc wedge resection of the lesion with surrounding tunica albuginea and seminiferous tubules, and gubernaculum sparing surgery. Postoperatively, the patient had an uneventful recovery and was discharged on the same day. Histopathological examination confirmed the diagnosis of Leydig cell tumor, with no high-risk pathological features observed. Regular follow-up intervals were scheduled to monitor for potential recurrence, emphasizing the importance of vigilant postoperative surveillance in cases of testis-sparing surgery for Leydig cell tumors.

Leydig cell tumor of the testis with characteristic contrast patterns of tumor and non-tumorous testicular parenchyma on MRI: a case report

PURPOSE

Testicular Leydig cell tumor (LCT) is a rare subtype of testicular neoplasms that occurs in the interstitial tissue of testes, accounting for 1-3% of total testicular masses removed annually. We report a case of 70-year-old man diagnosed as testicular LCT. This report demonstrates a testicular LCT with intratumoral and non-tumorous testicular parenchymal enhancement in the affected testis, which should be considered characteristic findings of LCT.

METHODS

Ultrasonography showed a hypoechoic mass. On magnetic resonance imaging, the tumor showed low signal intensity comparable to the surrounding testicular tissue on T1-weighted images (T1WI) and low signal intensity on T2-weighted images (T2WI). On gadolinium contrast-enhanced T1WI (CE-T1WI), the tumor showed a rapid and marked wash-in and subsequent prolonged washout. The spared, non-tumorous testicular parenchyma showed slow and progressive enhancement in the early phase, which was as strong as or stronger than that of the mass in the delayed phase. The patient underwent right orchiectomy.

RESULTS

Pathologically, the tumor was diagnosed as a testicular Leydig cell tumor (LCT). Leydig cell proliferation was observed with well-developed microvessels, atrophy of the seminiferous tubules, and stromal edema in the non-tumorous testicular parenchyma. Leydig cells in the non-tumorous parenchyma were positive for estrogen receptors.

CONCLUSION

Since the contrast findings in the non-tumorous testicular parenchymal region on CE-T1WI likely match the histopathological features of LCT, our case suggests that the presence of non-tumorous testicular parenchymal enhancement on imaging might indicate a diagnosis of LCT.

Bilateral congenital cryptorchidism and unilateral Leydig cell tumor in an adult presenting with gynecomastia and primary infertility: A case report

Introduction and importance

The neoplasms of the testis are sporadic tumors among men. Furthermore, the rarest subset of these is neoplasms belonging to the stromal tumors of the sex cord. Leydig cell tumors are the most common form among the testicular stromal tumors. In our case, the underlying risk factor associated with the development of Leydig cell tumors was cryptorchidism. While mostly unilateral, cases of bilateral cryptorchidism may be present and have been rarely reported.

Case presentation

We report a 36-year-old gentleman who presented to us with the inability to carry off intercourse without difficulty attaining erection on stimulation for the past two years. He had a history of left undescended testis since birth, for which he underwent left orchidopexy 20 years ago. An ultrasound of the pelvis showed an oval hypoechoic-shaped heterogeneous mass in the right mid-inguinal canal. Relevant blood investigations showed a deranged hormonal profile. He then underwent an uneventful right radical orchiectomy, histopathology of which was consistent with Leydig cell tumor.

Clinical discussion

LCT with a history of bilateral cryptorchidism has rarely been reported. This case highlights its clinical presentation, management, and further follow-up in such patients.

Conclusion

Bilateral congenital cryptorchidism may be associated with Leydig cell tumor years later in life hence long-term follow-up is required for these patients. The clinical presentation of these tumors may vary among individuals. Any change in physical appearance, hormonal assay, and imaging studies should promptly be followed for possible surgical resection and close monitoring.

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Bilateral congenital cryptorchidism may be associated with LCT, years later in life.

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The clinical presentation of these tumors may vary among individuals.

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Such patients need periodic monitoring of hormonal profiles and imaging studies.

Leydig cell tumor of the testis: an incidental finding at 18F-FDG PET/CT imaging

Background

Leydig cell tumors (LCTs) represent the most common form of stromal tumors. We reported the 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) findings of a patient with testicular LCT.

Case presentation

A 50-year-old man with a history of end-stage renal disease and renal transplantation 19 years ago. One year earlier, he started to have a chronic rejection. During the investigation to determine the cause of chronic rejection, a suspicious lesion in the graft with a collection around it was seen on ultrasound (US) images, raising the possibility of post-transplant lymphoproliferative disorder (PTLD). The patient was referred for further evaluation by whole body 18F-FDG PET/CT imaging. The image finding revealed an incidental hypermetabolic focal lesion in the right testicle—no other specific findings in the remaining parts of the body nor definitive FDG avid lymphadenopathy to suggest PTLD. Testicular US was requested and showed a well-defined right-sided heterogeneous hypoechoic intratesticular focal mass at the upper pole of the right testis with significant internal vascularity on the color Doppler imaging. The patient underwent a right radical orchidectomy, and the tumor was pathologically confirmed as an LCT.

Conclusion

In our case, 18F-FDG-PET/CT has been helpful in incidentally detecting this rare testicular tumor in a patient with suspected PTLD.

Testicular leydig cell tumor revealed by hydrocele

Leydig cell tumor (LCT) is a rare testicular tumor with a low incidence accounting 3% of all testicule neoplasms. Due to its rarity, the natural history of LCT is poorly understood. Patients can present with atypical symptoms and endocrine disorders. The diagnosis of LCT is based on histological and immunohistochemical examination. We report a new case of leydig cell tumor in a 61-year-old man presenting with a left testis hydrocele. The patient underwent a left orchidectomy and the diagnosis of LCT was established. Even in front of a benign pathology such as hydrocele, exploration is necessary to detect any testicle tumor.

Differentiation of testicular seminoma and nonseminomatous germ cell tumor on magnetic resonance imaging

Magnetic resonance imaging (MRI) has excellent soft tissue resolution, as well as multidirectional and multisequence scanning technology, making it an important supplementary method in the diagnosis of testicular tumor.To explore the utility of preoperative MRI for the differential diagnosis of testicular seminoma and nonseminomatous germ cell tumors (NSGCTs).The medical records from 39 patients with testicular tumors that were examined preoperatively with MRI and treated with urologic surgery at our institution between January 2015 and March 2019 were retrospectively reviewed. Testicular tumors were confirmed by pathology and classified as seminoma (n = 20) or NSGCT (n = 19). Two radiologists analyzed the testicular tumors on preoperative MRI for morphology: multiple nodules or a single mass; presence/absence of a capsule; signal compared to the normal contralateral testicle (isointense, hypointense, hyperintense, or mixed); enhancement; septa; and hemorrhagic or cystic degeneration. Characteristics of seminomas and NSGCT were compared using the Chi-square or Fischer exact test.MRI showed that the majority (95%; 19/20) of seminomas were nodular. There were significant differences in the presence/absence of a capsule (P = .001), T1-weighted imaging (T1WI) signal intensity (P = .047), T2-weighted imaging (T2WI) signal intensity (P < .001), septa (P < .001), and hemorrhagic or cystic degeneration (P < .001) between seminomas and NSGCT.Seminomas were more likely to have no capsule, isointensity on T1WI, hypointensity on T2WI, and had narrow obviously enhanced fibrovascular septa without hemorrhagic or cystic degeneration; NSGCT was more likely to have a capsule, a mainly mixed signal on T1WI and T2WI, most of them had no fibrovascular septa, and hemorrhagic or cystic degeneration was common in malignant NSGCT.This study suggests that preoperative MRI can distinguish seminoma from NSGCT. We propose that preoperative MRI of the scrotum is an effective technique that should be widely adopted for the management of scrotal disease.