Clinical cases

Leydig cell tumor US finding in older male


The Leydig cell tumor in young man cannot be rare, while it is very rare in elder men (only 1%).In this age diagnosis is due to the appearance of the gonadal mass, the malignant form prevails. The conventional US pattern is highly sensitive in locating the testicular tumors (approx 100% of cases).

The US finding is usually a hypoechoic homogeneous mono-lateral mass with clear borders [5-11]. Hyperechoic, non homogeneous and bilateral forms can also be found [12-14]. This feature is not pathognomonic and all testicular tumors, particularly impalpable ones, should be considered as seminoma until proven otherwise [15].
In patients older than 70-year-old metastasis and lymphoma are the most frequent neoplasms. Ultrasound appearance is not specific and an effective Ultrasonographic semeiology doesn’t exist. Color-Doppler and power-Doppler Us demonstrate increased vascularity in the majority of malignant tumors [16].
This data is not enough for a diagnosis of malignancy and it may be difficult to demonstrate increased blood flow in small neoplasms; especially if the color-Doppler equipment is not sensitive enough to capture slow flows.

Literature reports that peripheral hyper-vascularity in a hypoechoic testicular tumor with little or no internal color-Doppler flow could suggest a suspicious Leydig cell tumor [18].
In our experience gonadal mass and endocrine associated manifestations were absent; the small hypoechoic solid lesion was discovered incidentally. High sensitive color-Doppler ultrasound examination allows to locate a perilesional and minimal intralesional slow flow in the small size lesion, even if a benign character results from the histological final examination [19]. For these reasons we cannot associate lesion’s malignancy with its vascularity. A hypoechoic solid nodule can require a histological examination and orchifuniculectomy.