A 37-year-old male presented to the endocrinology service with bilateral painful gynecomas, without secretions and diminished for two years.
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On examination, a hard nodule was observed in the upper pole of the left testis, well delimited from the head of the epididymis and that was ultrasonographically hypoechoic, well delimited and vascularized.
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Laboratory tests that included testicular markers, alpha-fetoprotein and beta-HCG were normal; plasma estradiol was moderately high (54 pg/ml) and decreased testosterone was 0.8 ng/ml (values of 8).
Spermogram showed severe oligoastenospermia.
The possibility of performing conservative surgery was exposed to the clinical conviction that it was a Leydig cell tumor, but he rejected it radical after knowing the surgical treatment mostly used, making it preferable that surgery.
Inguinal orchiectomy and placement of testicular prosthesis were performed.
In the surgical specimen it was found that it was a very well-capsulated tumor with easy enucleation.
A study was also performed in fresh-frotis observing a large number of Reinke crystalloids.
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The histological study showed a well-defined, encapsulated testicular tumor composed of cells with large eosinophilic cytoplasm in nests or sheets.
These cells showed nuclei with mild anisocariasis and prominent prominence without forms a
No areas of hemorrhage or necrosis were observed.
The cells were vimentin and calretinin positive, being negative with AE1/AE3.
Free surgical edge.
In the non-tumoral testicular parenchyma, the seminiferous tubules show mild periitubular fibrosis, isolated atrophic groups and diffuse maturation of the germinal series.
The final diagnosis was leidigioma.
Eight months after the intervention, breast pain and gynecomastia had decreased by approximately half.
Estradiol and testosterone normalized.
The control sperm count improved but not motility.
