Tumor de Leydig simulando una neoplasia germinal

ResumenHallazgos principalesReportamos un caso de neoplasia de células de Leydig en un paciente varón de 25 años, sin factores de riesgo clásicos con evolución tórpida. Se analizó la histopatología de la masa tumoral y se encontró malignidad por lo que se decide realizar orquiectomía derecha, seguida de quimioterapia. Luego del tratamiento se halla metástasis pulmonar, adenopatías perihepáticas e hidronefrosis, falleciendo 2 meses después de su último ingreso hospitalario.Hipótesis del casoEl tumor de células de Leydig representa entre el 1-3% de todos los tumores testiculares. Se presentan a cualquier edad; sobre todo en la infancia y en la 3.a-6.a década de la vida. Aproximadamente el 90% son de curso benigno y el 10% son malignos, presentándose sobre todo entre la 5.a y la 6.a década de la vida, y están asociados con un tamaño > 5 cm y ginecomastia. Finalmente, es difícil predecir el comportamiento en términos histológicos.Repercusiones a futuroA pesar que los tumores de células no germinales son poco frecuentes, es importante considerarlos como diagnóstico para brindar el tratamiento óptimo y evitar resultados desafortunados.

Main findingsA case is presented of a Leydig cell neoplasm in a 25 year-old male patient with no classic risk factors with an atypical outcome. The tumour mass was histologically analysed and was found to have features compatible with a germ cell neoplasm. A right orchiectomy was performed, followed by chemotherapy. After treatment, pulmonary metastasis, lymph nodes, and peri-hepatic hydronephrosis were found. The patient died two months after his last hospital admission.Case hypothesisLeydig cell tumours account for 1% to 3% of all testicular tumours. They occur at any age, especially in children, and between the third and sixth decade of life. Around 90% are benign, and 10% are malignant; these latter usually occurring between 50 and 60 years old, and are associated with sizes larger than 5 cm and gynecomastia. Finally, it is difficult to predict the development of the disease based on histopathological observations.Promising future implicationsAlthough non-germ cell tumours are rare, it is important to consider them in the differential diagnosis of testicular tumours, particularly in those of non-seminoma origin. Immunohistochemistry is useful for the differentiation of testicular tumours in those cases when conventional histology shows no conclusive findings.