A 46-year-old patient consulted for pain in the hypogastrium, painful ejaculation, haemospermia and a sensation of heaviness in the testicles, attributed until then to a right varicocele that had been known for a year. His personal history included an episode of acute prostatitis one year prior to consultation.
On physical examination, the patient was in good general condition, had a right varicocele and no masses were palpable in both testicles. Rectal examination showed an irregular prostate, slightly enlarged with indurated areas and somewhat painful on examination.
A comprehensive urological ultrasound was requested, which showed a hypoechoic nodular image in the right testicle with surrounding hypervascularisation and a simple cyst in the left testicle.
The abdominal-pelvic CT scan showed several images in the liver that could correspond to metastases or haemangiomas. Subsequent MRI confirmed that they were haemangiomas. The chest X-ray showed no alterations.
Tumour markers and PSA values were normal. Alpha-fetoprotein: 6 ng/ml, beta-HCG: 0.1 ng/ml, PSA: 1.5 ng/ml.
In view of all these findings, it was decided to perform a radical right inguinal orchiectomy. Macroscopically, the specimen showed a nodular formation of identical colour to that of the testicular pulp measuring 2.5 x 1.8 x 1.5 cm in the upper pole of the testicle. The histopathological report was of a diffuse Leydig cell tumour infiltrating perineural spaces, adjacent capsular vascular channels and smooth muscle; moderate atypia and few mitoses.
After 10 years of follow-up, the patient is asymptomatic, no metastases have been observed and tumour markers have remained negative.
