Leydig Cell Tumor with Gynecomastia: Hormonal Effects of an Estrogen-Producing Tumor
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Abstract:
A patient with a testicular intersitial cell tumor and gynecomastia is reported. The testicular tumor was capable of aromatizing 8.3% testosterone. Spermatic venous samples taken from the tumor-bearing side had marked elevations of 17β-estradiol (E2), progesterone, and 17-hydroxyprogesterone (17O HP). The progesterone to 17OHP and 17OHP to androstenedione ratios suggested an enzymatic block of 17α-hydroxylase and 17–20 lyase, possibly secondary to locally produced E2. The E2 produced by the tumor appeared to suppress gonadotropin secretion. The plasma testosterone and gonadotropin levels rose within 7 days after the removal of tumor, and the gynecomastia began to decrease.Keywords:
Gynecomastia
Leydig Cell Tumor
Gonadotropin
Bilateral leydig cell tumors of testes are very rare. There is no evidence from literature that in the cryptorchid man, bilateral leydig cell tumors are prone to develop. We report a man with bilateral leydig cell tumors in association with unilateral cryptorchidism.
Leydig Cell Tumor
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Gynecomastia
Leydig Cell Tumor
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Leydig Cell Tumor
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Gynecomastia
Leydig Cell Tumor
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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.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.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 contrast-enhanced ultrasonography were performed by a radiologist having more than 10 years of experience. Demographic and clinical data were collected.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 480.5, p < 0.001), and yielded a high diagnostic accuracy (area under the receiver operating characteristic curve 0.954, 95% confidence interval 0.903-1).Contrast-enhanced ultrasonography demonstrated high diagnostic accuracy in identifying benign testicular lesions, such as Leydig cell tumours; they are the most common non-palpable tumours detected in infertile men and may benefit from enucleation.
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Objective To investigate the diagnostic value and clinical diagnosis experience of contrast-enhanced ultrasound(CEUS)of Leydig cell tumors.Methods CEUS performance,clinical data and ultrasound diagnostic analysis of one case of Leydig cell tumor were analyzed.Results According to the clinical manifestations and the related inspections,the indications for surgery were clear.During the operation,a section was frozen to consider the source of the sex cord tumor,the nature of which was indefinable.The right testis was radically resected.Leydig cell tumor was diagnosed by postoperative analayis of the parrafin sections and immunohistochemistry.No recurrence or metastasis was seen after six months of follow-up.Conclusion Leydig cell tumor is a relatively rare testicular tumor and has a tendency to become malignant.The reports of CEUS diagnosis of Leydig cell tumors are rare.There are no specific clinical manifestations and the relevant laboratory parameters are normal,resulting in Leydig cell tumors being confused with other malignant testicular tumors.Its preoperative diagnosis is difficult and the definitive diagnosis still relies on histopathological examination.
Leydig Cell Tumor
Contrast-enhanced ultrasound
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The case of a young man affected by Leydig cell tumor of the right testis, without gynecomastia and feminization signs is reported. The plasmatic level of testosterone, estrogenic hormones, APF and Beta-HCG were normal. The diagnostic and therapeutical aspects are discussed and the role of the radical orchifuniculectomy in T1N0M0 stage is pointed out.
Gynecomastia
Feminization (sociology)
Leydig Cell Tumor
Testicle
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Gynecomastia
Leydig Cell Tumor
Testicle
Gonadotropin
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Leydig Cell Tumor
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We present images of a 50-year-old man who referred for treatment of a classic Hodgkin lymphoma. While F-FDG PET/CT demonstrated a complete metabolic remission after chemotherapy, an increased F-FDG uptake of a right testicular lesion in F-FDG PET/CT and an unexplained bilateral gynecomastia were observed. A benign Leydig cell tumor was histopathologically proved after a right radical orchiectomy. The serum estradiol level was abnormally elevated reflecting the estrogen-secreting profile. This report highlights that a focal F-FDG uptake in the testicular region with unexplained gynecomastia should suggest the diagnosis of an estrogen-secreting Leydig cell tumor on F-FDG PET/CT.
Gynecomastia
Leydig Cell Tumor
Orchiectomy
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