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Joseph Junewick, MD FACR
over 6 years ago
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Testicular Leydig cell tumor

Case Detail

Anatomy: Genitourinary
Borders
Heather Borders, MD
Diagnostic Category: Neoplasia Benign
Created: over 4 years ago
Updated: over 4 years ago
Tags: PEDS
Modality/Study Types: US
Activities:
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History

Patient with history of small left testicle, presents for ultrasound for this reason.


Case Images


Diagnosis

Testicular Leydig cell tumor

Findings

Incidental homogeneous circumscribed hyopechoic mass with minimal internal calcification and associated internal hypervascularity.

Discussion

Approximately 4% of all testicular tumors arise from the cells forming the sex cords (Sertoli cells) and interstitial stroma (Leydig cells). Leydig cell tumors are the most common in this group, accounting for 1%–3% of all testicular tumors. They can be seen in any age group, with 20% of cases occurring in patients younger than 10 years. Most are benign, although they can infrequently be malignant.

Approximately 30% of patients will have an endocrinopathy secondary to secretion of androgens or estrogens by the tumor. The endocrinopathy may manifest as precocious virilization, gynecomastia, or decreased libido. Sex cord–stromal tumors may also manifest as a painless testicular mass without endocrine abnormalities.

Leydig cell tumors are generally small solid masses. At US, Leydig cell tumors are usually homogeneous and hypoechoic. Calcification has also been reported. At Doppler evaluation, Leydig cell tumors typically have prominent circumferential blood flow with a lack of internal vascularity. Their sonographic appearance is variable and is indistinguishable from that of germ cell tumors.

Reference

From the Archives of the AFIP. Tumors and Tumorlike Lesions of the Testis: Radiologic-Pathologic Correlation. January 2002 RadioGraphics, 22, 189-216.

From the Radiologic Pathology Archives: Precocious Puberty: Radiologic-Pathologic Correlation. November 2012 RadioGraphics, 32, 2071-2099.



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