SONOWORLD : Leydig Cell Tumor of the Testicle

Username

Password

173,401 Registered Members as of 04/21/2019.

JavaScript must be enabled in order for you to use Sonoworld.com in standard view. However, it seems JavaScript is either disabled or not supported by your browser. To use standard view, enable JavaScript by changing your browser options, then try again.

Pelvis » Scrotum And Testicles

Leydig Cell Tumor of the Testicle

« Back to Listing

Author(s) :

José Luis Volpacchio, MD

Maria Victoria Ramos, MD

Presentation This is a 35 year-old male patient who presented for presurgical assessment of left Inguinal hernia. Scrotal and inguinal ultrasound was requested.

Caption: Figure 1. Ultrasound of the left testicle, longitudinal (a.) and axial (b.)

Description: These images show a hypoechoic nodule (solid) in the left testicle, slightly heterogeneous that measures 7.8 mm x 5.7 mm x 5.2 mm in longitudinal, anteroposterior and transverse diameters.

Caption: Figure 2. Ultrasound of the left testicle, longitudinal scan with Power Angio.

Description: The nodule has predominantly peripheral and low internal vascular flow.

Differential Diagnosis

• Testicular tumor

• Lymphoma

• Metastasis

• Sarcoidosis

• Ectopic adrenal tissue

Final Diagnosis Testicular tumor: Leydig Cell Tumor

Discussion

Ultrasound can detect masses of the scrotum with a sensitivity of 100%. Its specificity ranges from 98% to 100% in distinguishing intratesticular from extratesticular masses. This is important because most of the extratesticular masses are benign whereas the majority of the intratesticular ones are malignant.

Testicular cancer accounts for 1% of neoplasms in men but is the most common malignant tumor in young men between 15 and 34 years old. The most frequent clinical manifestation is a painless scrotal mass (65% - 95%). Other symptoms include scrotal heaviness or lower abdominal pain (10%). A minority of the patients present with endocrine disorders, such as gynecomastia, impotence, loss of libido or precocious virilization. Interestingly, some tumors can disappear (“burned out tumors”) due to necrosis and scarring so that these patients have normal or smaller testicles but present at the stage of metastases.

Primary testicular neoplasms have been classified into two main categories: germ cells tumors (GCT) and non germ cell tumors (NGCT). Germ cell tumors represent 90- 95% of the total and they are the most common malignant neoplasm in young adults. The remainder 5% - 10% are non-germ cells tumors (NGCT) which are usually benign. Metastasis to the testis as well as Lymphoma are rare.

The most common GCTs are seminomas (S) and the next most common is mixed germ cell tumor (a type of non seminoma tumor). On US, seminomas are generally well- defined, hypoechoic and homogeneous lesions that can be multifocal. The mixed-germ cell tumors tend to be complex cystic masses (representing areas of necrosis, hemorrhage) and can present calcifications.

The NGCT include Leydig cells tumors (LCT) derived from the gonadal stroma and Sertoli cell tumors (SCT) derived from the sex cords. At ultrasonographic examination LCT are usually small, homogeneous and hypoechoic masses. Foci of hemorrhage and necrosis (cystic spaces and hyperecogenic foci) are present in 25% of the tumors, especially if they are large. With Color Doppler they may show mainly peripheral flow. However, Doppler US depends more on the size of the mass than on the histologic nature. In general, lesions greater than 15 mm are hypervascular whereas smaller lesions present as hypovascular masses.

Macroscopically, LCTs are circumscribed golden brown nodules, usually less than 5 cm, with homogeneous cut surface. Histologically, there are large round or polygonal cells with round central nucleus and abundant cytoplasm with characteristic rod-shaped Reinke crystals in 25% of cases.

As imaging findings cannot differentiate benign from malignant tumors, orchiectomy is often performed.

Case References

Vinay Kumar, Abul K. Abbas y Nelson Fausto. Spanish Version of the original English work of Robbins and Cotran Pathologic Basis of Disease, 7th edition. Copyright 2005 Elseviere España, S.A.. Genova, 17,3.º Madrid. España. ISBN: original edition: 0-7216-0187-1. ISBN:84-8174-841-2
Carol M. Rumack, Stephanie R. Wilson, William Charboneau, Deborah Levine. Diagnostic Ultrasound, 4th edition. Copyright © 2011 By Mosby, Inc., an affiliate of Elsevier Inc. 1600 John F. Kennedy Blvd. Ste 1800 Philadelphia, PA 19103-2899. ISBN: 978-0-323-05397-6
Tumors and Lesions of the Testis Tumorlike: Radiologic-Pathologic Correlation. Paula J. Woodward, Roya Sohaey, Michael J. O’Donoghue and Douglas E. Green. September 2002 RadioGraphics 22:189–216
US–MR Imaging Correlation in PathologicConditions of the Scrotum Woojin Kim, Mark A. Rosen, Jill E. Langer, Marc P. Banner, Evan S. Siegelman, Parvati Ramchandani. December 2007 RadioGraphics 27:1239–1253.

Other contents by this AuthorOther Cases in This Category

Pelvis >> Scrotum And Testicles

Uncomplicated acute epididymo-orchitis
A 25-year-old male, presents with a 1-day history of acute left-sided scrotal pain. He has no history of trauma.

Acute right epididymitis
A 25 year old male presents with a 1 day history of acute right-sided scrotal pain. He has no history of trauma.

Left varicocele
A 25 year old man presents with a dull pain in the left scrotum. There is no history of trauma or fever.

Acute left epididymitis
A 25 year old male, presents with a one day history of acute left-sided scrotal pain. He has no history of trauma.

Complicated acute epididymo-orchitis: with an epididymal abscess
A young adult male presents with a one day history of acute right scrotal pain. There is no history of trauma.

Germ cell tumor testis: NSGCT- embryonal carcinoma
A 32 year old male presents with painless left testicular swelling of 2 months duration. There is no history of trauma or fever.

Germ cell tumor testis:Seminoma
A 30 year old man presents with a painless left testicular swelling. A scrotal ultrasound was performed.

Left testicular and epididymal torsion
A 25 year old man presents with severe, acute left scrotal pain of a few hours duration. The onset was sudden and not preceded by trauma. A scrotal ultrasound was performed.

Bilateral spermatoceles
A 60 year old man presents with bilateral palpable scrotal masses. He had a vasectomy performed 25 years ago. A scrotal ultrasound was performed.

Epidermoid cyst of the testicle
A 19 year old male presented with a unilateral non tender testicular mass. The patient gives a history of gradual increase in size of the mass. A scrotal ultrasound was performed.

Complicated acute epididymo-orchitis: with testicular infarct
A 30 year old male presented with severe, acute pain in the left scrotum. A scrotal ultrasound was performed.

Germ cell tumor testis: multifocal NSGCT
A 22 year old male presents with left testicular firmness. He has no history of trauma. A scrotal ultrasound was performed.

Tunica albuginea cyst
A 32 year old male presented for a follow up testicular ultrasound. He had an initial scan performed for a palpable left scrotal swelling.

Zinner syndrome
A 32 year old man presented for infertility. Semen analysis revealed oligo-asthenospermia. A scrotal and pelvic scan was performed.

Traumatic testicular rupture with cord hematoma
A young man fell into a well and sustained severe acute blunt injury to the right inguinal region. Clinically he presented with a grossly edematous penis and scrotum. The swelling extended up to ...

Scrotal calculi
A 50 year old doctor with history of repeated self- limiting attacks of excruciating/shooting pain localized to the left testis. The pain subsides after a minute or two. He has no other symptoms

Benign testicular calcification
A 30 year old man presents for infertility evaluation. A scrotal ultrasound was performed.

Scrotal sac hematoma
These are serial ultrasound scans of a young man with a history of trauma to the scrotum.

Leiomyoma of the epididymis
A 59 year-old man presents with two palpable masses in right hemiscrotum. An ultrasound of the scrotum was performed.

Right undescended testis
This is a scan in a 6-month-old male child with an empty right scrotal sac. An ultrasound was performed to locate the undescended testis.

Testicular microlithiasis
This is an incidental finding in a 35-year-old man with dull pain in the scrotum.

Atrophic right testis
This was a follow-up scan in a 35-year-old man with a previous history of right orchitis.

Granulomatous orchitis
This is a scrotal ultrasound scan in a man with complaints of hematuria.

Cystic dilatation of the Rete Testis
A 51-year-old male presents with left scrotal enlargement.

Leydig Cell tumor
An ultrasound evaluation for varicocele was performed on a 10 year old male, with normal blood sub-beta and alpha fetoproteins markers.

Partial Testicular Torsion
A 20 year old male presented to the emergency room with severe left scrotal pain.

Orchitis with abscess formation and hydrocele
54 year old male with scrotal pain and swelling.

Acute idiopathic scrotal edema
5 year old boy with a red painful swollen scrotum

Neonatal extravaginal testicular torsion
Neonate with a scrotal swelling on the right side

Testicular Microlithiasis
This 26 YO male presented for a scrotal ultrasound as an outpatient with no specific medical history on the referral. On questioning he stated that one side of his abdomen was harder and more ...

Testicular Seminoma
A 37-year-old man presents with a complaint of a painless mass in his left testicle. On examination there is testicular enlargement on the left.

Congenital Adrenal Hyperplasia
42 year old male presented with enlargement of both testicles

Bilateral Extravaginal Testicular Torsion
Clinical examination of the neonate revealed a swollen, red and firm scrotum bilaterally. Neither testicle could be individually palpated. No cremasteric reflex observed. No trauma to scrotum ...