Abstract
Background: The majority of Leydig cell tumors (LCTs) are found in males, usually when they have 5–10 years of age. Children typically present with precocious puberty due to excessive testosterone secreted by the tumor, one-third of female patients present a recent history of progressive masculinization. Alkaline phosphatase is normally at low levels. Case Presentation: A 30-year-old male referred to the hospital with a complaint of fever, chills, nausea and weight loss, and history of diabetes mellitus type 1. In the physical examination of testis, no abnormal findings were revealed. Scrotal ultrasonography demonstrated a small (7.5 ×4.8 mm) mass which seemed to be very vascular and suggestive of neoplastic lesion. Echogenicity of the head of the right epididymis was heterogeneous and the small cyst of about 4.5 mm was present on it. Left testis had normal size and no space occupying lesion in it. The hormonal test revealed high levels of alkaline phosphatase, ferritin, FSH and LH, normal level of testosterone, LDH, β-HCG and α-feto-protein. Immunohistochemistry results revealed negative CD30, alpha-fetoprotein and CK results, but calretinin, vimentin and S-100 were positive in tumor cells. Conclusions: LCTs are rare testicular tumors arising from male gonadal interstitium and very rare in adulthood. Because this tumor consists of immature embryonic tissues it can be accompanied by an elevation in alkaline phosphatase level.
Highlights
The majority of Leydig cell tumors (LCTs) are found in males, usually when they have 5–10 years of age
Leydig cell tumor is a rare germ cell tumor that originates from gonadal stroma, accounting for about 15 to 3% of testicular neoplasms in adults and about 4% in pediatric patients who have not yet reached maturity [1]
It is rare for LCT to be diagnosed with a malignancy
Summary
Leydig cell tumor is a rare germ cell tumor that originates from gonadal stroma, accounting for about 15 to 3% of testicular neoplasms in adults and about 4% in pediatric patients who have not yet reached maturity [1]. Leydig cells are named after Franz Leydig They are interstitial cells located between the seminiferous tubules. The hormonal test revealed high levels of alkaline phosphatase, ferritin, FSH and LH. Other findings such as β-HCG-, ALT, AST, LDH, ESR, CRP, RF, CBC and urine analysis were normal. The testicular parenchyma represented a neoplasm, composed of proliferated cells, having round vesicular nuclei with nucleoli nest and abundant granular cytoplasm, at times clear and vascularized. They were closely packed with intervening congested vessels and forming a circumscribed nodule (Figure 1). Abdominopelvic and chest CT scanning, bone scan and MRCP were normal
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