Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion.
Florian MaxwellAlexia SavignacOmar BekdacheSandra CalvezCedric LebacleEmmanuel AramaNada GarroucheLaurence RocherPublished in: Cancers (2022)
Pre-operative testicular tumor characterization is a challenge for radiologists and urologists. New data concerning imaging approaches or immunochemistry markers improve the management of patients presenting with a testicular tumor, sometimes avoiding radical orchiectomy. In the past 20 years, imaging modalities, especially ultrasound (US) and magnetic resonance imaging (MRI), improved, allowing for great progress in lesion characterization. Leydig cell tumors (LCT) are rare testicular tumors developing from the stromal tissue, with relatively scarce literature, as most of the studies focus on the much more frequent germ cell tumors. However, with the increase in testicular sonography numbers, the incidence of LCT appears much higher than expected, with some studies reporting up to 22% of small testicular nodules. Multimodal ultrasound using Doppler, Elastography, or injection of contrast media can provide crucial arguments to differentiate LCT from germ cell tumors. Multiparametric MRI is a second intention exam, but it allows for extraction of quantifiable data to assess the diagnosis of LCT. The aims of this article are to review the latest data regarding LCT imaging features, using multimodal ultrasound and multiparametric MRI, and to focus on the peculiar aspect of the testis of patients with Klinefelter's syndrome. The possibility of an LCT should be raised in front of a small hypoechoic tumor with a marked corbelling hypervascularization in an otherwise normal testicular pulp. Ultrasonographic modules, such as ultrasensitive Doppler, contrast-enhanced ultrasonography, or elastography, can be used to reinforce the suspicion of LCT. MRI provides objective data regarding vascularization and enhancement kinetics.
Keyphrases
- germ cell
- contrast enhanced
- magnetic resonance imaging
- diffusion weighted
- computed tomography
- high resolution
- diffusion weighted imaging
- magnetic resonance
- electronic health record
- big data
- systematic review
- single cell
- pain management
- emergency department
- risk factors
- fluorescence imaging
- bone marrow
- ultrasound guided
- stem cells
- cell therapy
- photodynamic therapy
- mesenchymal stem cells
- blood flow