Successful management of Leydig Cell Tumor in a 65-year-Old patient: A rare case report

Abstract

Leydig cell tumors (LCTs) are rare testicular neoplasms, representing 1–3% of all testicular tumors. A 65-year-old male presented with a painless left scrotal mass. Ultrasound revealed a 61 × 53 × 35 mm tumor with heterogeneous echogenicity and abundant blood supply. Radical orchidectomy was performed, and immunohistochemistry confirmed LCT with positivity for Inhibin A and calretinin, and negativity for CK, chromogranin, LCA, and low Ki67. Postoperative follow-up at 6 months showed improved condition, no scrotal masses, and normal tumor markers. Finally, LCTs in older males require differential diagnosis; hormonal activity impacts presentation. Conservative management and monitoring are crucial.

1 Introduction

Leydig cell tumors (LCTs), which are uncommon testicular tumors found in the male gonadal interstitium, represent the most frequent type of sex cord-stromal tumors, accounting for 1–3% of all testicular neoplasms. The majority of LCTs are typically identified in males aged 20–60 years, although around a quarter have been documented before puberty. While the majority exhibit benign behavior, 10 % are malignant, possibly metastasizing. A typical clinical manifestation includes the presence of a painless testicular mass, which may or may not be accompanied by endocrine symptoms. Scrotal ultrasound is essential for diagnosing the tumor, while magnetic resonance imaging (MRI) is effective in detecting concealed LCTs. If malignancy is suspected, computed tomography (CT) scanning is advised. Histopathological examination is necessary to confirm the presence of leydig tumors. Currently, the primary approach to treating LCTs is radical orchiectomy. This paper describes a patient’s case who came with a painless left-sided scrotal swelling, ultimately diagnosed with LCT. Following a successful radical orchidectomy, the patient’s condition stabilized.

2 Case presentation

A 65-year-old male presented to the department of urology with painless scrotal swelling. The patient has hypertension and a gastric ulcer. Clinical examination revealed a mass in the scrotum developing on only one side (left side) a month ago.

Laboratory tests, including prothrombin time (PT) and international normalized ratio (INR), and tumor markers such as alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase, were all within normal limits.

Doppler ultrasound of the testicles and spermatic cords revealed a mass in the left testicle with blurred margins, characterized by heterogeneous echogenicity. These findings suggest a tumor mass measuring approximately 61 × 53 × 35 mm occupies most of the left testicle, with abundant blood supply within it, and a lack of resistance at a speed measuring approximately 55 × 29 cm/second [ Fig. 1 ].

A radical orchidectomy was performed [ Fig. 2 ]. Through a traditional oblique inguinal incision, the spermatic cord was gently mobilized at the level of the pubic tubercle. Applying gentle traction to the spermatic cord in a cephalad direction and external pressure to the ipsilateral hemiscrotum, the testis within its tunica vaginalis was gently pushed into the surgical field. Ligation of the spermatic cord, hemostasis, and closure were completed.

Pathological examination after radical orchiectomy in the resected section of the testicle by hematoxylin and eosin staining showed a brown mass measuring 4 × 25 cm. They consist of monoclonal polygonal cells with abundant eosinophilic granular cytoplasm, uniform round nuclei, and a central nucleolus. The tunica albuginea and tunica vaginalis are intact. No nodules were detected within the adipose tissue [ Fig. 3 ].

Immunohistochemical examination showed that the tumor cells were positive for Inhibin A and calretinin, and negative for creatine kinase (CK), chromogranin and leukocyte common antigen (LCA) and Ki67 was less than 1 %, confirming the diagnosis of a LCT [ Fig. 4 ].