Commentary to “Precocious puberty in a 7-year-old boy: A novel case”

The authors present an unusual case of precocious puberty secondary to an unclassified type of mixed germ cell tumor. The tumor differs from a ‘classic’ MGST in that only the germ cells have a high proliferative index. More importantly, the tumor differs from classic forms in that it is the apparent cause of virilization. To date, there are no reported cases of MGST and virilization in the absence of Leydig cell hyperplasia. The authors clearly state that Leydig cell hyperplasia was absent; however they give no explanation for the elevation in testosterone. Possible clues to this problem can be found in women with gonadoblastoma/dysgerminomas,