Hiperplasia secundaria de células de Leydig como tumor testicular bilateral: reporte de un caso

J.S. Izquierdo-Luna, J.C. López-Silvestre, J.G. Campos-Salcedo, E.I. Bravo-Castro, M.Á. Zapata-Villalba, L.A. Mendoza-Álvarez, C.E. Estrada-Carrasco, H. Rosas-Hernández, J.L. Reyes-Equihua, J.J. Torres-Gómez, C. Díaz-Gómez, J.J.O. Islas-García, J. Aguilar-Colmenero, O. Gómez-Abraján, S.A. Gil-Villa, C.A. Reyes-Moreno, D. Ayala-Careaga
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Abstract

Background

Leydig cell hyperplasia is a rare benign condition characterized by small, multifocal testicular nodules that are frequently bilateral. Its form can be primary or secondary. The former produces precocious puberty in boys and the latter presents as a testicular mass and produces gynecomastia in approximately 30% of the patients as a result of idiopathic supraphysiologic hormone stimulation, and has clinical manifestations similar to those of Leydig cell tumors.

Clinical case

A 30-year-old man with an unremarkable past history, the father of two children, was seen at a primary care hospital for pain and swelling of the right testis that was resolved with nonsteroidal antiinflammatory drugs. Ultrasound study revealed bilateral testicular tumor. The patient had no palpable testicular mass or gynecomastia or other relevant signs or symptoms. The ultrasound finding was confirmed by magnetic resonance imaging and retroperitoneal activity was ruled out from tomography scan results. Exploration of the right testis was carried out with the inguinal approach. The incisional intraoperative biopsy revealed a millimetric mass protruding from the healthy parenchyma. It was reported as undetermined in the intraoperative study and so radical orchiectomy was completed. The definitive histopathology study stated Leydig cell hyperplasia. The patient refused any invasive diagnostic procedure in the contralateral testis. His postoperative progression was favorable with no changes in imaging studies in the contralateral testis during follow-up.

Conclusion

This was a case of atypical secondary Leydig cell hyperplasia whose definitive diagnosis was made through the final histopathology study of the specimen, the only manner in which to accurately rule out a Leydig cell tumor.

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背景:间质细胞增生是一种罕见的良性疾病,其特征是小的、多灶性的睾丸结节,通常是双侧的。它的形式可以是主要的或次要的。前者在男孩中导致性早熟,后者在约30%的患者中由于特发性生理上激素刺激而表现为睾丸肿块并导致男性乳房发育,其临床表现与间质细胞瘤相似。临床病例:一名30岁男性,既往病史一般,两个孩子的父亲,因右睾丸疼痛和肿胀在一家初级保健医院就诊,并使用非甾体类抗炎药解决。超声检查显示双侧睾丸肿瘤。患者无可触及的睾丸肿块或男性乳房发育症或其他相关体征或症状。超声发现经磁共振成像证实,腹膜后活动从断层扫描结果中排除。右睾丸探查采用腹股沟入路。术中切口活检显示一个毫米大小的肿块从健康实质突出。据报道,术中研究未确定,因此完成了根治性睾丸切除术。最终的组织病理学研究表明间质细胞增生。患者拒绝对侧睾丸进行任何侵入性诊断。术后进展良好,随访期间对侧睾丸影像学检查无变化。结论:本病例为非典型继发性间质细胞增生,通过对标本的最终组织病理学检查才能做出明确诊断,这是准确排除间质细胞瘤的唯一方法。
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来源期刊
Revista mexicana de urologia
Revista mexicana de urologia Medicine-Urology
CiteScore
0.20
自引率
0.00%
发文量
49
期刊介绍: Revista Mexicana de Urología (RMU) [Mexican Journal of Urology] (ISSN: 0185-4542 / ISSN electronic: 2007-4085) is bimonthly publication that disseminates research by academicians and professionals of the international medical community interested in urological subjects, in the format of original articles, clinical cases, review articles brief communications and letters to the editor. Owing to its nature, it is publication with international scope that disseminates contributions in Spanish and English that are rigorously reviewed by peers under the double blind modality. Neither journalistic documents nor those that lack rigorous medical or scientific support are suitable for publication.
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