(259) One Case of Primary Pediatric Leydig Cell Tumor in the Unilateral Testis and Literature Review

Introduction A 10-year-old little boy with the discovery of left testicular mass for more than a week presented to our urology department.One week ago, the patient visited the hospital due to frequent erections. The color ultrasound examination revealed a mass in the lower part of the left testicle, measuring approximately 9.3 * 5.5 mm (Figure 1a),while no obvious nodules were found in the testicles during physical examination.Subsequently,abnormal signals in the left testicle was detected by MRI,with clear enhancement visible (Figure 1b). The serum testosterone level has abnormally increased to 6 nmol/l，while LH and FSH was in normal level. We performed tumor excision surgery for this patient.We carefully examined the left testicle and no obvious abnormalities were found. During the operation, ultrasound was used to locate the mass. After the incision, a brown mass approximately 7.0 mm × 7.0 mm × 7.0 mm in size was discovered (Figure 1c). The final postoperative pathology was consistent with testicular stromal cell tumor (Figure 1d). Objective To explore the clinicopathological characteristics of children Leydig cell tumors and determine the appropriate surgical treatment methods. Methods Leydig cell tumor (LCT), also known as testicular interstitial cell tumor, originates from testicular interstitial cells and is a relatively rare non germ cell tumor of the testis. Our hospital admitted one pediatric patient with testicular interstitial cell tumor, and the following report is based on literature review. Results We performed tumor excision surgery for this patient considering that previous studies have suggested that cases in the pre-adolescent stage are mostly benign. We carefully examined the left testicle and no obvious abnormalities were found. During the operation, ultrasound was used to locate the mass. The final postoperative pathology was consistent with testicular stromal cell tumor. Conclusions Leydig cell tumor (LCT) is a non-germ cell tumor and a type of testicular sex cord-stromal tumor. It is relatively rare and can occur at any age, but is more common in children and adults. Most LCTs are benign, with about 10% being malignant. Malignant LCTs have not been found in prepubertal testicles. The exact mechanism of its occurrence is still unclear. For this patient, we found that the testosterone level was significantly abnormally elevated, resulting in frequent erection. Notably, frequent erections is a symptom that is easily overlooked since the patients are usually unwilling to speak out. Therefore, Color Doppler ultrasound is the most commonly used diagnostic method,which revealed a solitary, quasi-circular mass with a well-defined boundary, exhibiting low or moderate echogenicity, and abundant blood flow signals within the mass.Furthermore,MRI showed sporadic LCTs are well-delimited solid masses with regular margins. The testicular-sparing surgery (TSS) that retains the testicles can be chosen, especially for patients before puberty, those with bilateral testicular stromal cell tumors, or those with a single testicle, especially when the intraoperative frozen pathological histology examination confirms it to be a benign testicular stromal cell tumor. Disclosure No