Bilateral Leydig cell tumor of the testis: a

Abstract

Leydig cell tumors are rare testicular tumors of the male gonadal interstitium. Although uncommon, Leydig cell testicular neoplasms are the most common sex cord-stromal tumors and comprise 1–3% of all testicular neoplasms. This tumor is always benign in children and approximately 90% are benign in adults. In most cases, patients present with an incidental finding of a testicular mass on scrotal ultrasonography during evaluation of hydroceles or varicoceles or during diagnostic workup for infertility. Leydig cell tumors have been primarily managed with radical inguinal orchiectomy. However, conservative management with testis-sparing surgery in younger adults and children were reported in the literature. Here we report a case of bilateral Leydig cell tumor of the testis treated with radical orchiectomy who presented with the complaint of infertilityand no disease recurrence in followup for 9 months. The patient is currently disease-free and under androgen supplemantation for androgen insufficiency. We recommend complete exam and diagnostic workup in patients with infertility and azoospermia.

Leydig cell tumor of testis in a child: An uncommon presentation

“…Leydig cell tumors (LCTs) are rare testicular tumors arising from male gonadal interstitium[ 1 ] and most common type of testicular sex cord-stromal tumor. [ 2 3 ] Adult male between 20- and 60-year age group usually affected[ 4 ], prepubertal (most often between 5 and 10 years of age)[ 5 ] children are also affected in 20% of cases. [ 6 ] Testicular swelling, decreased libido (20%), and gynecomastia (15%) are common symptoms in adults, but in children only a few cases had been reported and that are associated with pseudopuberty.…”

Case – A tale of two boys: An atypical cause of pubertal precocity

“…5,8 Reinke crystals are pale staining inclusions that are pathognomonic for LCT but only found in 30-35% of patients. 8,13 Testicular LCT traditionally were managed with radical inguinal orchiectomy. However, the majority of tumors have been found to be benign and radical orchiectomy might be considered over-treatment.…”

“…In turn, LCTs that had favorable pathology or were benign were treated via conservative testes-sparing procedures whereby tumor enucleation is completed. 13,14 This approach to treatment has preserved testicle functionality preserving fertility in these patients. 6 Observation is thought to be sufficient post-operatively to manage patients with benign LCT.…”

“…6 Observation is thought to be sufficient post-operatively to manage patients with benign LCT. 13 Malignant LCT is generally managed with radical inguinal orchiectomy with retroperitoneal lymph node dissection (RPLND) for patients with unfavorable prognostic indicators (i.e. older, unfavorable pathology).…”

Testis-Sparing Surgery for Non-Palpable Leydig Cell Tumors in Prepubertal Children

“…Despite the fact that these lesions have shown a favorable outcome, a follow-up is essential for a long period with physical and imaging (US) examination. Until now, there is only one case of malignant LCT in a 9-year-old child, but with bilateral testicular involvement and with mass dimensions on one side greater than 6 cm [16].…”