Abstract
Gynaecomastia is the most common benign breast disorder in men. Among the various causes, testicular malignancies are an uncommon, life-threatening condition requiring prompt diagnosis and treatment. The case of a 28-year-old man is discussed, who presented with a 6-month history of painful bilateral gynaecomastia with no abnormality on clinical or biochemical examination. The patient's symptoms spontaneously resolved within 4 weeks. He then represented 10 years later with similar symptoms and an associated secondary hypogonadism. Ultrasound imaging revealed a clinically occult, hypoechoic mass in the left testis (Leydig cell tumour on histology). Clinical and hormonal findings normalized following surgical excision. This report underlines the importance in clinical practice of ultrasonographic evaluation of the testis, in all patients with gynaecomastia, despite unremarkable findings on physical examination.
Highlights
With an increasing incidence of testicular cancer over the last 30 years, public awareness campaigns have led to men seeking reassurance from urologists about a multitude of testicular symptoms
Leydig cell tumours (LCT) are rare testicular neoplasms that account for 1–3% of all testicular neoplasms[1,2]
We report a case in which bilateral gynaecomastia was induced by an occult testicular LCT
Summary
With an increasing incidence of testicular cancer over the last 30 years, public awareness campaigns have led to men seeking reassurance from urologists about a multitude of testicular symptoms. Men may present with endocrine manifestations (such as gynaecomastia) of a functioning testicular tumour. Leydig cell tumours (LCT) are rare testicular neoplasms that account for 1–3% of all testicular neoplasms[1,2] They typically present in adults between the ages of 30–35 years as a testicular mass or with endocrine disturbance. TheScientificWorldJOURNAL (2005) 5, 884–887 underline the importance of a thorough biochemical and physical examination in any patient presenting with unexplained gynaecomastia in order to exclude the possibility of an occult testicular tumour. At 6-month follow-up, the gynaecomastia had resolved spontaneously and the patient was discharged from clinic He represented 10 years later with recurrent bilateral grade II gynaecomastia. The bilateral gynaecomastia resolved and the patient was discharged from follow-up endocrine clinic at 1 year (he continues to undergo regular urology surveillance)
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