A 26-year-old patient with a history of Perthes disease in the right hip, who consulted his doctor two years ago for enlargement and right breast pain.
The patient was lost to follow-up for a year and a half, and then returned to the endocrinology service due to gynaecomastia and bilateral breast pain, accompanied by mild sexual appetite.
The examination confirmed the existence of bilateral right gynecomastia.
In an analytical study repeated on three occasions the normality of tumor markers was checked, in which alpha-fetoprotein and beta-HCG were included.
Hormonal study was normal for prolactin, FSH, LH, testosterone and AHEAD; only estradiol in three determinations was in ranges above normal (57.59 and 62 pg/mL 11-44 pg/mL normal in males).
Mammography and breast ultrasound confirmed the proliferation of fibroglandular tissue in both regions retroare, predominantly bilateral as arboriform aspect of the right breast and more nodular in the left breast, findings consistent with gynecomas
Endocrinology service requested testicular ultrasound although both tests did not show pathology or nodules.
Testicular ultrasound of the right testicle showed a hypoechogenic solid mass of 1.15 x 1.85 cm, with a bilobulated external contour, with internal content of the same something heterogeneous, alternating with more hypoechogenic zones.
Normal left testicle.
The extension study was performed by means of TAC that was normal.
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With the presumption that it could be a hormone-producing testicular tumor, Sertoli or Leydig cell type, radical orchiectomy was performed, calling attention not even to the palpable tumor.
Upon opening the albuginea, a well-defined tumor of the healthy testicular parenchyma was observed.
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In the histological study of the tumor, abundant, eosinophilic or vacuolated cytoplasmic cells were observed, rounded structures with prominent cytoplasmic or central nuclei, growing with solid and a crystalloids pattern.
The neoplasm was limited to the testicle and showed little mitotic activity; surgical margins, testicular coverings, epididymis and cord are free.
The diagnosis was Leydig cell testicular tumor (LCT).
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One year after surgery, hormonal studies, including plasma estrogens, are normal.
The gynaecomastia returned completely.
Spermogram was not performed prior to orchiectomy, nor did it allow it to be performed later.
