(853) Beyond Fertility: Preserving Manhood Through Testis-Sparing Surgery

Introduction Leydig cell tumor (LCT) is a relatively rare testicular tumor, consisting the most common non-germ cell testicular tumor, accounting for 1-3% of all testicular malignancies. Most LCTs are benign, but 10% of them are malignant. They usually present as a testicular mass and they may be associated with azoospermia. We present a case of a man presenting with azoospermia, unilateral LCT and hypoplastic testicles, who underwent an organ sparing surgery and a micro-TESE on both sides. Objective Testis-sparing surgery (TSS) is traditionally indicated for fertility or endocrine preservation in men with testicular masses. However, its value often extends beyond these goals-organ preservation can play a crucial role in maintaining psychosexual identity and the sense of manhood, particularly in men with limited gonadal reserve. Methods A 50-year-old man was referred for infertility evaluation. His history included childhood mumps and a prior left varicocelectomy, which enabled fatherhood via assisted reproduction in an earlier marriage. The patient presented 2 consecutive semen analyses suggesting azoospermia. Clinical examination revealed severely hypoplastic right testicle of nonfirm context and a less hypoplastic left testicle with a slightly palpated mass in the middle. Scrotal ultrasonography showed hypotrophic testicles, mostly right, with a hypoechoic mass with hypervascularization in the middle of the left, about 1 cm in diameter. Tumor markers, such as β-hCG, αFP, and LDH were in normal range. FSH and LH levels were elevated and testosterone level was at lowest normal. Scrotal MRI revealed a mass in the left testicle, compatible with a testicular tumor. Abdomen & thorax CT were normal. Results Despite low fertility potential, testis-sparing surgery was performed to preserve both organ integrity and the possibility of sperm retrieval. Intraoperative exploration was facilitated with microscopic vision and ultrasound assistance which has been excised over clean margins. The resected specimen was a brown homogeneous solid mass, well circumscribed, 1 x 0.7 x 0.3 cm in dimension. Additional margins were obtained for frozen section biopsy. The first pathology report was of sex cord-stromal tumor, suggestive for LCT, with free margins and spermatozoa were successfully retrieved from surrounding testicular tissue. Micro-TESE on both testicles was performed allowing spermatozoa extraction with freezing. Histopathology report confirmed LCT. Tumor cells were large, polygonal, with abundant eosinophilic cytoplasm and discrete cellular borders. Nuclei were subround with prominent nucleolus. Rare mitoses were apparent and stroma was fibrous. Immunohistochemical stains were positive for inhibin, CD99, Calhretinin, focally positive for Mart-1 and negative for CD30. Ki-67 index was approximately 2%. Final diagnosis was benign LCT. During IVF, 7 oocytes were collected, 6 of them were normally fertilized, 2 embryos were transferred and 4 were frozen. A singleton pregnancy was confirmed after 14 days and finally a healthy baby girl was born. Conclusions In modern oncofertility practice, “preservation” encompasses more than hormones or gametes-it can also restore identity, confidence, and the possibility of fatherhood. This case highlights how TSS can address both biological and psychosexual dimensions of male reproductive health. Even in the context of compromised fertility, testicular preservation may provide functional sperm retrieval and profound psychological reassurance. Disclosure No