Precocious puberty related to Leydig cell testicular tumor: the diagnostic imaging keys

Abstract

Background We report the challenging case of a 6-year-old boy with precocious puberty related to histologically proven Leydig cell tumor. Case presentation Multiparametric ultrasound and magnetic resonance imaging (MRI) was performed. Interesting findings were scarcely or never reported in children and differed from adults Leydig cell tumors s such as the hyperechogenic halo surrounding the lesion and the dominant central vascularization using ultrasensitive Doppler. MRI revealed an enlarged testicle with strong enhancement of a tumor, a tumor apparent diffusion coefficient (ADC) of 600 × 10−3 mm2/s and a lower ADC value of the non-tumor parenchyma compared to the contralateral testis (ADC = 800 × 10−3 mm2/s vs 1100 × 10−3 mm2/s), attributed to the spermatogenesis induced by hormonal impregnation. Conclusion We illustrate multiparametric US and MRI findings of a pediatric Leydig cell tumor, including the imaging changes attributed to local hormone secretion, which may be helpful in similar cases.

Multimodal ultrasound diagnosis of epididymo‐orchitis with secondary testicular infarction: A case report

“…The echogenicity within the mass is usually homogeneous, and hemorrhage and necrosis are uncommon findings. Color Doppler reveals abundant blood flow signals within and around the lesion 26,27 . Elastography shows increased stiffness of the lesion, and CEUS depicts it as exhibiting heterogeneous hyperenhancement 21,28 .…”

“…Color Doppler reveals abundant blood flow signals within and around the lesion. 26,27 Elastography shows increased stiffness of the lesion, and CEUS depicts it as exhibiting heterogeneous hyperenhancement. 21,28 MRI findings demonstrate Leydig cell tumors as isointense on T1WIs and as markedly hypointense on T2WIs, with prominent homogeneous enhancement.…”

Multiparametric Ultrasound for Diagnosing Testicular Lesions: Everything You Need to Know in Daily Clinical Practice

“…GSUS + CDUS: LCTs commonly appear in GSUS as round lesions with homogeneous hypoechoic echotexture and regular well-demarcated margins [40,119]. A hyperechoic halo surrounding the lesion can sometimes be found [120] (Figure 13, Panel A). Dimensions are usually small due to the slow cell growth, and they usually present as single lesions.…”

Imaging of Pediatric Testicular and Para-Testicular Tumors: A Pictural Review

“…On US, typical LCTs appear as an isolated moderately hypoechoic mass with well-defined margins without microlithiasis and predominant hypervascularization [44]. In children, some additional features have been described such as the central vascularization on ultrasensitive Doppler or the hyperechoic rim surrounding the lesion, that could be useful to distinguish LCT from testicular adrenal rest tumors (Figure 5) [45]. On CEUS with Sonazoid, LCTs demonstrate a strong and fast enhancement pattern followed by a delayed washout in the lesion [46].…”

“…On CEUS with Sonazoid, LCTs demonstrate a strong and fast enhancement pattern followed by a delayed washout in the lesion [46]. On elastography, case series report a moderate increase in stiffness [26,45]. On MRI, LCTs have been reported with low signal intensity on T2-weighted imaging, with enhancement after contrast administration, which could mimic the aspect of malignant testicular tumors.…”