Testis sparing surgery for Leydig cell pathologies in children

SummaryObjectiveThe aim was to analyze testis-sparing surgical procedures in boys with Leydig cell pathologies.Study designThe hospital records of four boys with Leydig cell hyperplasia who underwent testis-sparing surgery for testicular masses between 2000 and 2012 were analyzed retrospectively. Tumor markers were evaluated and all boys underwent scrotal ultrasonography preoperatively. The hormonal profile was also analyzed for symptoms of precocious puberty. The testis was delivered through a high transverse inguinal incision and the tumor was excised by enucleation. After confirming the benign nature of the tumor with frozen-section examination, the testis was reinserted and fixed into the scrotum with absorbable sutures. All cases were followed-up with physical examination, scrotal ultrasonography, and measurement of β-human chorionic gonadotropin (HCG), α-fetoprotein, and hormone levels.ResultsThe mean age of the patients was 9.4 years (1.5-15 years). Testicular mass and scrotal asymmetry were detected in all cases. Ultrasonography was the main initial diagnostic modality for detecting testicular masses (Table). β-HCG and α-fetoprotein levels were normal. Three cases had Leydig cell hyperplasia and one patient was diagnosed to have a Leydig cell tumor. Signs of precocious puberty were detected in the four patients. The mean follow-up period was 4.8 years (2-8 years). Neither recurrence nor testicular atrophy developed in the follow-up. Findings of precocious puberty continued in one patient with Leydig cell hyperplasia, in whom a 2-mm contralateral metachronous lesion was detected and enucleated successfully.DiscussionTestis-sparing surgery with its potential long-term psychological, cosmetic, and functional advantages should be used in pediatric patients in whom a benign Leydig cell pathology is confirmed histopathologically.ConclusionThis intervention with good long-term results can easily be applied through a proper dissection plane in the testicle. Since testicular Leydig cell tumors in childhood have small rates of recurrence, this choice of treatment is efficient in patients with salvageable testicular tissues and normal levels of tumor markers.Table. Laboratory and ultrasound findings with final diagnosis.CaseAge (years)SidePreoperative levelsTestis volume (mL)DiagnosisFollow-up period (years)AFPβ-HCGTestosteroneContralateral testis volumeTestis volume with mass110RightNNTotal: 531 ng/dLFree: N/A1.42Leydig cell hyperplasia3215LeftNNTotal: 440 ng/dLFree: 3.91 pg/mL1214Leydig cell hyperplasia93a1.5MetachronousNNTotal: 842 ng/dLFree: 2.6 pg/mL1.21.6Leydig cell hyperplasia3411LeftNNTotal: 125.4 ng/dLFree: 0.6 pg/mL1.41.8Leydig cell tumor4Note. Normal (N) ranges: total testosterone (2-32 ng/dL); free testosterone (3.84-34.17 pg/mL). AFP = α-fetoprotein; β-HCG = β-human chorionic gonadotropin.aEnucleation was performed in case 3 because of a subsequent contralateral tumor.