Multiparametric ultrasound for the diagnosis of Leydig cell tumours in non‐palpable testicular lesions

Abstract

Background:The widespread use of ultrasonography has led to an increased number of incidentally detected small non-palpable lesions, with Leydig cell tumours representing the majority of them. Objectives:The ultrasonography, real-time elastography and contrast-enhanced ultrasonography features of a large series of non-palpable testicular lesions were evaluated, focusing on the differences between Leydig cell tumours and other testicular masses. Materials and methods:Of the 4679 testicular ultrasonography examinations performed at the Authors' Institution between January 2009 and December 2018, 78 patients (1.7%) were incidentally diagnosed with at least one non-palpable lesion and were enrolled. Thirteen patients (16.6%) declined surgery and were thus excluded.The remaining 65 underwent surgical resection with frozen section analysis. The conventional ultrasonography, colour Doppler, real-time elastography and contrastenhanced ultrasonography were performed by a radiologist having more than 10 years of experience. Demographic and clinical data were collected.Results: Leydig cell tumours were detected in 32 patients, being the most frequent benign tumours (49.2%); of the non-Leydig cell tumours, 25 patients had malignant tumours, five non-neoplastic lesions and three other benign tumours. The Leydig cell tumour group had mostly infertility problems whereas the non-Leydig cell tumour group frequently experienced pain (p < 0.001). Leydig cell tumours were all hypoechoic (32/32, 100%; p = 0.002), more frequently presented with well-defined margins compared to non-Leydig cell tumours (30/32, 93.8% vs. 19/33, 57.6%; p = 0.001) and tended to be smaller than non-Leydig cell tumours (5.3 mm [standard deviation 2.7 mm] vs. 10.6 mm [standard deviation 3.8 mm], respectively; p < 0.001). The vascular pattern characterised by the rapid wash-in followed by the delayed wash-out observed during contrast-enhanced ultrasonography was significantly associated with the Leydig cell tumour histological diagnosis, even at multivariate analysis (odds ratio

Ultrasound contrast‐enhanced diagnosis of testicular Leydig cell tumor: A case report and literature review

“…This is consistent with our findings (Table 1), where hormonal disturbances seem to be the main reason for patients with LCT to seek medical attention, rather than testicular pain. Carmignani L 18 also reported a 43% incidence of LCT in patients with testicular tumors referred for infertility, while Corcioni B 19 found a 49.2% incidence in a similar study, highlighting a close association between high incidence rates and referral centers for infertility. In pediatric patients with LCT, signs of precocious puberty appear to be more common, such as rapid growth acceleration, advanced bone age, and early appearance of secondary sexual characteristics.…”

“…When LCT are larger or atypical, they may show heterogeneous enhancement, but most LCT demonstrate slow washout in the late phase of contrast imaging. Corcioni B 19 also analyzed contrast‐enhanced ultrasound in 32 LCT patients and 33 non‐LCT patients, and found that 96.9% of LCT showed a pattern of rapid enhancement followed by slow washout, with clearer margins compared to non‐LCT tumors. They also attributed this enhancement pattern to the rich vascularity both peripherally and internally in LCT, which may help differentiate them from seminomas characterized by irregular neovascularization and presence of necrotic areas.…”

“…On the other hand, Lock G 24 performed elastography in five LCT patients and obtained results indicating a “harder” consistency compared to the surrounding testicular tissue. In a study by Corcioni B 19 which evaluated 25 LCT patients using elastography, 9 patients had “harder” results, 16 had “intermediate” results, but they acknowledged that these findings were operator‐dependent and had limitations.…”

Contrast-enhanced echocardiographic diagnosis of benign and malignant cardiac tumors and its correlation with pathology

“…TPI, TPI/MPI and AUTIC, which represent the microcirculation perfusion of tumors ( 17 ), showed significant differences in benign and malignant tumors. However, there was no difference in TPK and slope value between the benign and malignant groups, the two CEE parameters represent tumor blood perfusion velocity and may be related to the increase in neovascularization in malignant tumors ( 18 ). Necrosis may occur inside some large and fast-growing malignant tumors without sufficient blood supply, which affects the peak intensity measurement ( 19 ).…”

Elastography of the Male Pelvic Region—Perspectives on Malignant Lesions

“…Elastography of the scrotum is easily and rapidly performed without any additional discomfort to the patient. Both SE and SWE have been used in the assessment of testicular lesions [ 49 , 51 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. SE elastography aims to assess tissue stiffness by quantifying tissue deformation, whereas SWE measures the speed of propagation when applying force [ 17 , 63 ].…”