Leydig cell tumor of the testis

Last revised by Dr Jeremy Jones on 20 Sep 2021

A Leydig cell tumor of the testis is an uncommon testicular neoplasm. Its imaging appearance on ultrasound and MRI is nonspecific, but clinically it is associated with serum hormonal imbalance.

1-3% of all testicular tumors, but the most common sex-cord stromal tumor. Tend to be bimodal, with one peak occurring in pediatric patients (5-10 years) and one in adults (20-30 years).  Malignancy occurs in ~10% of tumors.

Leydig cell tumors arise from the interstitial cells of Leydig adjacent to the seminiferous tubules.

Leydig cell tumors of the testis may present with serum hormonal imbalance (~30%). Virilization (including precocious puberty) may occur. Hyperestrogenism may also occur and patients may demonstrate gynecomastia.

Malignancy cannot be excluded on imaging.

  • small, hypoechoic, round intratesticular mass
  • may demonstrate cystic areas
  • most often unilateral
  • difficult to differentiate from other testicular tumors

On an imaging differential, consider:

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Cases and figures

  • Case 1: on ultrasound
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