Leydig cell tumor of the testis with characteristic contrast patterns of tumor and non-tumorous testicular parenchyma on MRI: a case report.

PURPOSE: Testicular Leydig cell tumor (LCT) is a rare subtype of testicular neoplasms that occurs in the interstitial tissue of testes, accounting for 1-3% of total testicular masses removed annually. We report a case of 70-year-old man diagnosed as testicular LCT. This report demonstrates a testicular LCT with intratumoral and non-tumorous testicular parenchymal enhancement in the affected testis, which should be considered characteristic findings of LCT. METHODS: Ultrasonography showed a hypoechoic mass. On magnetic resonance imaging, the tumor showed low signal intensity comparable to the surrounding testicular tissue on T1-weighted images (T1WI) and low signal intensity on T2-weighted images (T2WI). On gadolinium contrast-enhanced T1WI (CE-T1WI), the tumor showed a rapid and marked wash-in and subsequent prolonged washout. The spared, non-tumorous testicular parenchyma showed slow and progressive enhancement in the early phase, which was as strong as or stronger than that of the mass in the delayed phase. The patient underwent right orchiectomy. RESULTS: Pathologically, the tumor was diagnosed as a testicular Leydig cell tumor (LCT). Leydig cell proliferation was observed with well-developed microvessels, atrophy of the seminiferous tubules, and stromal edema in the non-tumorous testicular parenchyma. Leydig cells in the non-tumorous parenchyma were positive for estrogen receptors. CONCLUSION: Since the contrast findings in the non-tumorous testicular parenchymal region on CE-T1WI likely match the histopathological features of LCT, our case suggests that the presence of non-tumorous testicular parenchymal enhancement on imaging might indicate a diagnosis of LCT.

[Primary Diffuse Large B-Cell Lymphoma of the Spermatic Cord : A Case Report].

A 66-year-old man came to our department with the chief complaint of a right inguinal painless mass. He was diagnosed with a right spermatic cord tumor and underwent a right high orchiectomy with wide excision. The results of hematoxylin eosin staining and immunostaining procedures showed mucosa-associated lymphoid tissue (MALT) lymphoma originating from the lymphoid tissue of spermatic cord. The patient was referred to the department of hematology at another hospital for treatment. As results of additional immunostaining procedures at that hospital, the pathological diagnosis was diffuse large B-cell lymphoma (DLBCL). The positron emission tomography-computed tomography revealed no residual tumor or metastasis, and the final diagnosis was primary DLBCL Stage I of the spermatic cord. The patient was treated with 6 courses of R-THP-COP, 2 courses of Rituximab, and 3 courses of intrathecal chemotherapy, including Methotrexate, Ara-C, and Prednisolone. In addition, prophylactic radiation therapy to another testis was planned. Primary DLBCL of the spermatic cord is rare, and the standard treatment is the same as that for testicular DLBCL.

Two cases of pelvic lymphocele after prostatectomy and dissection of obturator lymph nodes successfully treated by interventional radiology.

INTRODUCTION: Postoperative refractory lymphocele is often difficult to treat. Recently, interventional radiology with N-butyl-cyanoacrylate has been used by urologists and radiologists to treat lymphocele. This modality is an effective treatment with fewer complications. CASE PRESENTATION: Case 1. A 70-year-old man, who underwent retropubic radical prostatectomy and bilateral obturator lymph node dissection, developed postoperative lymphocele. Continuous drainage and multiple rounds of sclerotherapy to reduce lymphocele volume ended in failure. Subsequently, lymphangiography with lipiodol and N-butyl-cyanoacrylate was performed, and the lymphocele volume gradually decreased.Case 2. A 75-year-old man underwent retropubic radical prostatectomy and bilateral obturator lymph node dissection. After surgery, the patient developed a high-output lymphocele. The lymphocele volume decreased following lymphangiography with lipiodol. CONCLUSION: Interventional radiology using lipiodol and N-butyl-cyanoacrylate could provide a new standard treatment for refractory lymphocele.

Serous borderline tumor of the paratestis.

Reported herein is a case of serous borderline tumor (SBT, ovarian epithelial type tumor) of the paratestis, involving the tunica vaginalis, in a 64-year-old man. The patient complained of right hydrocele; puncture cytology of the turbid fluid pointed to an adenocarcinoma. Right orchiectomy was performed and multiple micronodules were grossly observed in the paratestis. On microscopy small papillary epithelial lesions were found with psammoma bodies and intraglandular papillary lesions were irregularly recognized in the stroma of the paratestis, similar to SBT of the ovary. The tumor cells had often short microvilli. Mucin production was evident on PAS and colloid iron staining. Both papillary and glandular epithelial cells were positive on immunohistochemistry for Ber-EP4/epithelial antigen, low-molecular-weight cytokeratin (CAM5.2), cytokeratin 7 and estrogen and progesterone hormone receptors, but negative for CEA, cytokeratin 20 and calretinin. The average proliferative index was approximately 10.5% as assessed on Ki-67 (MIB-1) staining. Ultrastructurally, the cells did not demonstrate any well-developed microvilli or secretory granules and immunohistochemical findings supported SBT of Müllerian type (ovarian epithelial type tumor), while excluding a papillary type of malignant mesothelioma. The lesion in the present case was concluded to be a testicular serous tumor of Müllerian type, similar to SBT of the ovary.