Atypical leydig cell tumor in a young child.

Abstract

The Leydigioma is a rare tumor of the testicle. It develops from the proliferation of the interstitial cells or Leydig cells, and compete with the endocrine activity of this organ.[1] It usually arises between 20 year and 50 year of life, and rarely reported in children.[2] International literature is rich about the management of testicular tumors in adults and often recommends radical orchidectomy. Few reports of pediatric Leydig cells tumors exist in literature.[2, 3] The tumor cells produce androgen hormones and manifests with precocious physical and sexual development.[4] Rarely the tumor is asymptomatic. We report a case of asymptomatic Leydig cell tumor managed by testis sparing surgery. A 5-year-old boy was admitted for the management of left inguinal hernia. Clinical examination of right testicle showed 3 ml volume and normal location with an incidental palpation of a right testicular mass; the left testicle was of 2 ml volume with normal position. Testicular ultrasound of right testicle showed a 5 mm hyperechoic nodule at lower pole. The hormonal assessment (including LH, FSH, testosterone, 17-hydroxyprogesteron and dehydroepiandrostenedione) and the tumor markers (α-FP, Beta HCG, CA125 and CEA) were unremarkable. Magnetic resonance imaging of the lower abdomen and the pelvic cavity was normal and moreover it showed a 5 mm area of hypointensity located at the lower pole of right testis. The tumor was approached via transscrotal approach under caudal anesthesia. There was a gray brown colored nodule of 5 mm inside the testicular parenchyma. (Fig.1, 2) The nodule was enucleated with gentle electro-cautery. We did not conduct a peripheral frozen biopsy due to the well circumscribed aspect of the lesion. In the same session left inguinal herniotomy was done. The postoperative period was uneventful. The histological report demonstrated the diagnosis of a benign well differentiated Leydig cell tumor. The patient is being followed-up with clinical examinations, ultrasonography, chest x-rays, and tumor markers twice a year and doing fine.