Three cases of Leydig cell tumor with different clinical presentation

Coronado Lorena Hidalgo; Gabriela Rampi; Oscar Brunetto; Claudia Hernandez

Leydig cell tumors(LCTs) are rare testicular tumors, representing 1-3% of them. They are usually unilateral but can be bilateral up to 3%. Its incidence is bimodal, peaking at 5-10 years (20%) and 25-35 year (80%). Malignant transformation has not been clearly proven in children, whereas in adults they are malignant in 10% of cases. The main clinical manifestation is a palpable, painless testicular mass associated in a variable percentage with endocrinological manifestations that vary according to the age of onset. In prepubertal patients, signs of early virilization are nearly constant and may occur before the testicular abnormality. During puberty, the diagnosis is often difficult as the symptoms are masked by the normal pubertal development. Orchiectomy has been the classical treatment, however, the testicular sparing surgery can be performed on those who meet the criteria for benignity of the testicular mass. Surgical excision of the tumor is frequently curative, with arrest and partial regression of clinical signs.

We describe three patients with LCTs with different clinical presentation.

Patients(P) characteristics


P	Age at diagnosis (years)	Reason for consultation	Physical examination			Bone age
Tanner stage	Age at diagnosis (years)	Reason for consultation	Testis volume with mass	Contralateral testis volume		Bone age
1	8,33	Precocious puberty	PH 3 G 2	6ml	2ml	13,5
2	11,16	Testicular pain (hydatid torsion)	PH 4 G 3	6ml	8ml	14
3	11,5	Follow up for history of precocious pubarche	PH 4 G 3	6 ml	8-10ml	14
PH: pubic hair, G: genitalia Laboratory test and treatment

P	Pre surgery levels					Surgery	Post surgery levels
P	LH mUI/ml	FSH mUI/ml	To ng/dl	β- HCG	AFP		LH mUI/ml	FSH mUI/ml	To ng/dl
1	<0,1 (0,7- 2)	<0,2 (0,16-3,5)	190 (10- 32)	N	N	tumorectomy	3,6	3,5	97,7
2				N	N	orchiectomy	11,2	2,2	183
3	2,04 (0,3- 4,4)	4,54 (0,4-6)	406 (15- 280)	N	N	tumorectomy
LH: luteinizing hormone, FSH: follicle-stimulating hormone, To: testosterone, AFP: alpha-fetoprotein, β-HCG: β-human chorionic gonadotropin


Post surgery treatment	Post-GnRH analog treatment
LH mUI/ml		FSH mUI/ml	To ng/dl
triptorelin		0,7	0,3	<2,5
aromatase inhibitor

We report three patients with LCTs who consulted for diferent reasons. We found in the anamnesis that all had a history of signs of early virilization. These cases highlight the importance of investigating the presence of testicular tumors using complementary imaging methods in boys with early virilization, especially in prepubertal patients but also in those with early puberty.

ESPE Abstracts

P2-