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CASE REPORT
Year : 2020  |  Volume : 7  |  Issue : 1  |  Page : 17-19

Incidental leydig cell tumor in a detorted testis


1 Department of Urology, Jupiter Lifeline Hospital, Thane, Maharashtra, India
2 Department of Radiology, Jupiter Lifeline Hospital, Thane, Maharashtra, India
3 Department of Pathology, Jupiter Lifeline Hospital, Thane, Maharashtra, India

Date of Submission08-May-2020
Date of Decision04-Jan-2021
Date of Acceptance24-Feb-2021
Date of Web Publication24-Aug-2021

Correspondence Address:
Dr. Ajay S Kanbur
Department of Urology, Jupiter Lifeline Hospital, Eastern Express Highway, Thane - 400 601, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jina.jina_3_20

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  Abstract 


Leydig cell tumors form 1%-3% of all testicular tumors. We report a case of incidental Leydig cell tumor in a case of detorted testis.

Keywords: Benign testicular neoplasm, leydig cell tumor, torsion testis


How to cite this article:
Kanbur AS, Talawdekar S, Taware K, Dutta S. Incidental leydig cell tumor in a detorted testis. J Integr Nephrol Androl 2020;7:17-9

How to cite this URL:
Kanbur AS, Talawdekar S, Taware K, Dutta S. Incidental leydig cell tumor in a detorted testis. J Integr Nephrol Androl [serial online] 2020 [cited 2021 Dec 3];7:17-9. Available from: http://www.journal-ina.com/text.asp?2020/7/1/17/324501



A 31-year-old unmarried male presented in emergency with right testicular pain and swelling of 2 h duration. There was no fever or trauma. He had no comorbid conditions.

On clinical examination, he had normal vitals. The right scrotum was enlarged and tender with tenderness over right cord suggesting funiculitis. The left scrotum was normal.

Emergency color Doppler scrotum revealed right testis to have an oval hypo echoic lesion about 8 mm × 6 mm with increased local vascularity indicative of neoplasm [Figure 1]. This testis also showed monophasic arterial flow, normal venous flow, and mild fluid collection with septae indicating? Early torsion. Left testis was normal. Laboratory investigations including Serum AFP and beta HCG were normal.
Figure 1: Hypoechoic lesion in testis with increased local vascularity on Doppler

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The patient underwent emergency scrotal exploration in view of torsion. On right side, the testis was dusky blue but the epididymis was pink and inflamed [Figure 2]. The cord did not appear twisted, indicating de-torsion of the testis. Intraoperative color Doppler confirmed the preoperative findings. A horizontal equatorial incision made on the tunic of right testis to release the pressure if any. The color did not improve. A soft clamp was placed on the cord. There was a subcentimeter tumor at mid-pole which was excised with adequate margin. Warm mops and Papaverine local injection did not improve the color on clamp release. The frozen section was reported as Seminoma. Hence, after consent of relatives, he underwent a radical inguinal orchiectomy. The left testis was explored and fixed to prevent future torsion.
Figure 2: Dusky testis with pink epididymis

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Postoperative recovery was uneventful. The final histopathology reported was Leydig cell tumor with no features of malignancy [Figure 3]. The IHC was inhibin A positive for [Figure 4], which is a specific marker for such tumors.[1]
Figure 3: Leydig cell tumor with no features of malignancy

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Figure 4: Inhibin A positive on IHC as seen in Leydig cell tumor

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  Discussion Top


Leydig cell tumors (ICD code of D29.20) comprise 1%–3% of adult testicular neoplasms and 3% of testicular tumors in infants and children. These tumors can be pure or can be mixed with other sex cord-stromal or germ cell tumors. Leydig cell tumors are usually benign, but approximately 10% are malignant.[2]

They are usually hormonally active and can cause either virilizing or feminizing syndromes. Since our patient presented in an emergency with suspected early torsion, his baseline hormone investigations were not done. Furthermore, the lesion on ultrasound and frozen section was suspected as a seminoma, which is the most common testicular tumor. The rationale for testis-sparing surgery is that testicular sex cord stromal tumors differ from germ cell tumors as they are not multifocal, are not associated with precancerous lesions and have shown a low rate of local recurrence. These aspects seem to be appropriate premises to justify testis-sparing surgery in the case of testicular sex cord stromal tumors.[3] However, in our case, circumstances such as torsion with neoplasm on frozen section prompted orchiectomy rather than testis sparing surgery.


  Summary Top


Torsion in a tumor laden testis is not uncommon. Such tumors are usually large and further the cause of torsion. Benign tumors are also known to cause torsion.[4] A subcentimeter Leydig cell tumor associated with torsion is rare in being incidental and anecdotal.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Iczkowski KA, Bostwick DG, Roche PC, Cheville JC. Inhibin A is a sensitive and specific marker for testicular sex cord-stromal tumors. Mod Pathol 1998;11:774-9.  Back to cited text no. 1
    
2.
Albers P, Albrecht W, Algaba F, Bokemeyer C, Boormans JL, Fischer S. European Association of Urology. EAU Guidelines on Testicular Cancer. UROWEB. ORG; 2017. Available from: https://uroweb.org/wp-content/uploads/11-Testicular-Cancer_2017_web.pdf. [Last accessed on 2020 May 08].  Back to cited text no. 2
    
3.
Bozzini G, Picozzi S, Gadda F, Colombo R, Decobelli O, Palou J, et al. Long-term follow-up using testicle-sparing surgery for Leydig cell tumor. Clin Genitourin Cancer 2013;11:321-4.  Back to cited text no. 3
    
4.
Slawin J, Slawin K. Intratesticular epidermoid cyst masquerading as testicular torsion. Rev Urol 2014;16:198-201.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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