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

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.