MP91-15 LEYDIG CELL ULTRASOUND FEATURES: A USEFUL TOOL FOR A PROPER PREOPERATIVE COUNSELLING

Abstract

INTRODUCTION AND OBJECTIVES: The aim of this study is to clarify Leydig Cell Tumor (LCT) ultrasound features to distinguish them in the characterization of both benign and malignant intratesticular lesions. Normally, testicular neoplasms, either malignant or benign, demonstrate an alteration in the normal homogenous testicular ultrasound outcome, besides this there are no typical and described features to drive preoperative surgical approach. METHODS: From January 2007 to July 2014 we reviewed the scrotal ultrasound images of all patients diagnosed with Leydig cell Tumor and treated with conservative surgery (group A). We considered only patients that were first diagnosed at one of the participating centers. We create a random homogenous control group of patients (B), in term of age and presentation, different from the group A just for the definitive malignant histology. All the images were collected and we analyzed ultrasound features of the lesions classified in terms of length, US lesion homogeneity, shape, presence of hypervascularization. The collected data were analysed by an online regression (Student’s t-test, chi-square test, and logistic regression analysis). RESULTS: From January 2007 to July 2014, 35 patients with Leydig cell tumor underwent conservative surgery at our centers. A random group B of 35 patients was also considered. Patient mean age was 35,11 years (range 28 to 45) for the first group and 33,89 years for the second one (range 22 to 41). Patients presented either with a palpable testicular nodule (12 patients group A, 34.28% 29 patients 82,86% group B) or a nodule diagnosed by ultrasound (23 patients group A, 65.72% 6 patients 17.14% group B). Mean ultrasound size was 0.96 cm and 1.57 cm for the two groups respectively (range 0.25 to 1.8 cm and 0.8 to 3 cm). Both groups had hypervascularization of the lesions with no significant differences. Patients presenting with LCT (group A) had an homogenous ultrasound intralesional aspect and the shape is defined with an elliptic or spheroid mold while patients from group B had dis-homogenous intralesional aspect and non-defined margins (p>0.05). CONCLUSIONS: Ultrasound is a sensitive and accurate technique for the evaluation of testicular abnormalities, and is widely accepted as the first-line imaging technique for many common and uncommon testicular diseases. Ultrasound is effectively the sole scrotal imaging technique that a patient will undergo prior to surgery, but does not provide histological diagnosis. Although most focal lesions will be malignant and require an orchiectomy, recognition of the benign entity may be challenging. In a small lesion mainly not palpable the presence of a well-defined shape with an homogenous intralesional ultrasound aspect do correlate with a LCT.