Leydig cell tumor of the testis presenting with gynaecomastia due to hyperprolactinemia after orchiectomy

Abstract

Leydig cell tumors (LCT) are rare and represent 1% to 3% of all tumors of the testis. LCTs can either be benign or malignant with clinical presentation varying from testicular mass associated with endocrinal manifestations to metastatic lesions in case of malignant tumors. We describe a 25-year-old man who presented with an isolated painless mass of the left testes which was confirmed by ultrasonography. An orchiectomy was subsequently performed and the histopathological analysis revealed a leydig cell tumor. Three months after surgery, the patient presented with bilateral gynaecomastia; estradiol, testosterone and gonadotropin levels as well as tumor markers (carcinoembryonic antigen (CEA), alpha-fetoprotein (AFP) and human chorionic gonadotropin ( β-HCG) were within normal ranges but prolactin was high in two different measurements. No evidence of tumor recurrence or metastases was found and different underlying causes of hyperprolactinemia including use of drugs, pituitary adenoma, hypothyroidism and renal failure were ruled out. After 6 month of treatment with Cabergoline the prolactin level and breast size were remarkably reduced. Patients with benign LCT have a favourable prognosis but in order to rule out tumor recurrence or a persistent effect of their hormonal disorder, follow-up should include regular hormonal and imaging studies.