A 35-year-old patient who was referred to the emergency department of our hospital by a local urologist due to ultrasound findings compatible with testicular neoplasia.
His personal history included bilateral cryptorchidism that was treated with orchidopexy at 6 and 8 years of age, respectively, at another centre. Endoscopic urethrotomy at the age of 20. She had presented repeated nephritic colic with expulsion of lithiasis and had even required treatment with ESWL. Ureterolitectomy at 28 years of age. Smoker of 1 pack of cigarettes/day.
One month earlier, he had consulted the local urologist for sterility and a nodule on the left testicle that had been developing for months and had increased in size in recent weeks. The spermiogram showed total azoospermia. The testicular Doppler ultrasound was reported as a 19 x 23 mm mass in the upper pole of the right testicle with increased flow, compatible with a testicular tumour and a left cord cyst.
Physical examination revealed an unaltered left testicle with epididymal cyst in the head. The right testicle could not be explored as it was in the inguinal canal.
The study was completed. The chest X-ray was normal and the thoraco-abdominal-pelvic CT scan showed no metastases. The blood test showed no abnormalities either in serum hormone values or tumour markers (alpha-fetoprotein 2.2 ng/ml, beta-HCG 0.0 ng/ml).
A radical right inguinal orchiectomy and biopsy of the left testicle via the inguinal route were performed. The macroscopic report of the specimen was as follows: right testicle measuring 3.2 x 3 cm. The testicular surface is smooth with no infiltration of the tunica vaginalis. When cut, a well-defined solid nodule of 1.5 cm in diameter with a brownish colour and a yellowish area in the centre was identified. The remaining testicular tissue is orange in colour. The spermatic cord is unaltered. The biopsy of the left testicle is a 0.3 cm fragment of brownish colour.
The histopathological report stated: Leydig cell tumour measuring 3.2 x 3 cm with no infiltration of the epididymis, tunica albuginea or vascular invasion. Remaining testicular parenchyma with atrophy, hyperplasia of Leydig cells in the interstitium and virtual absence of spermiogenesis. Surgical edges free. Biopsy of the left testis was reported as testicular atrophy with absence of spermiogenesis and interstitial Leydig cell hyperplasia.
After 30 months of follow-up, the patient is in good general condition with no radiological evidence of metastasis and tumour markers within normal values.
