title: Contrast-enhanced ultrasound and real-time elastography for the diagnosis of benign Leydig cell tumors of the testis - a single center report on 13 cases.
abstract: OBJECTIVE
  To describe sonomorphological features in testicular Leydig cell tumors (LCTs) with a special focus on contrast-enhanced ultrasonography (CEUS) and real-time elastography (RTE).
  
  
  METHODS
  In a series of 186 patients with testicular surgery for neoplastic disease, 13 benign LCTs (in 12 patients) were histopathologically diagnosed. Preoperatively, all patients had been examined with a standardized protocol (high-resolution grayscale and color-coded ultrasonography, CEUS). 5 patients underwent RTE. In CEUS, the filling time of the lesion was compared to that of 14 size-matched germ cell tumors (GCT).
  
  
  RESULTS
  10/13 LCTs had a size of < 10 mm, and a sharply demarcated hypoechoic appearance was typical (10/13). Color-coded ultrasonography detected signals in 8 lesions, while CEUS showed clear hypervascularization in all. LCTs had a significantly shorter filling time than GCTs (p < 0.0005), with 9/13 LCTs being completely filled within 4 s. In RTE, all 5 examined lesions were clearly "harder" than the surrounding testicular tissue.
  
  
  CONCLUSIONS
  Contrary to some earlier reports, we could demonstrate marked hypervascularization in LCTs. This feature clearly allows for the differentiation of a small LCT from focal scars. However, it may only be visible on CEUS. In CEUS, LCT is suggested by the findings of a short filling time or by a circumferential vessel with a rapid centripetal filling, combined with a "harder" appearance in RTE. These features along with the findings of a small and peripherally situated hypoechoic tumor would justify an operative strategy with frozen section examination and possibly organ sparing surgery instead of orchiectomy.
authors.affiliation: Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg.
authors.forename: G
authors.initials: G
authors.lastname: Lock
authors.affiliation: Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg.
authors.forename: C
authors.initials: C
authors.lastname: Schröder
authors.affiliation: Department of Internal Medicine, Albertinen-Krankenhaus, Hamburg.
authors.forename: C
authors.initials: C
authors.lastname: Schmidt
authors.affiliation: Department of Urology, Albertinen-Krankenhaus, Hamburg.
authors.forename: P
authors.initials: P
authors.lastname: Anheuser
authors.affiliation: Institute of Pathology, Albertinen-Krankenhaus, Hamburg.
authors.forename: T
authors.initials: T
authors.lastname: Loening
authors.affiliation: Department of Urology, Albertinen-Krankenhaus, Hamburg.
authors.forename: K P
authors.initials: KP
authors.lastname: Dieckmann
mesh_terms: D000328:Adult; D000368:Aged; D003287:Contrast Media; D054459:Elasticity Imaging Techniques / Q000379:methods*; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D007984:Leydig Cell Tumor / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013736:Testicular Neoplasms / Q000098:blood supply / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013737:Testis / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018615:Ultrasonography, Doppler, Color / Q000379:methods; D055815:Young Adult
chemical_list: D003287:Contrast Media