A 46-year-old patient presented with hypogastric pain, painful ejaculation, hemospermia and testicular weight sensation attributed to right varicocele for a year.
His personal history included an episode of acute prostatitis one year before the consultation.
On physical examination, the patient presented good general condition, right varicocele and did not present masses in both testicles.
The rectal examination showed an irregular prostate, slightly increased in size with indurated areas and somewhat painful on examination.
An integral urological ultrasound was requested which showed a hypoechoic nodular image in the right testis with surrounding hypervascularization and a simple cyst in the left testicle.
In the abdominal-pelvic CT several images were observed in the liver that could correspond to metastases or hemangiomas.
Later MRI confirmed the presence of hemangiomas.
The chest X-ray showed no abnormalities.
Tumor markers and PSA showed normal values.
Alpha-fetoprotein: 6 ng/ml, beta-HCG: 0.1 ng/ml, PSA: 1.5 ng/ml.
Given these findings, we decided to perform a right inguinal radical orchiectomy.
The specimen, macroscopically, presented a nodular formation of identical color to that of the testicular pulp of 2.5 x 1.8 x 1.5 cm in the upper pole of the testicle.
Histopathology revealed diffuse Leydig cell tumor involving perineural spaces, adjacent vascular channels, smooth muscle and moderate to severe mitoses.
After 10 years of follow-up, the patient is asymptomatic, with no evidence of metastasis and negative tumour markers.
