表现为无精子症的睾丸间质细胞瘤的诊断与治疗(1例报告及文献复习)

Leydig cell tumor with azoospermia: A case report and literatures review

目的探讨睾丸间质细胞瘤导致的无精子症诊断和治疗经验。方法报告1例睾丸间质细胞瘤导致的无精子症患者的临床资料并文献复习。患者男,24岁,已婚,因"婚后规律性生活1年未育"就诊,行精液检测示正常精液容量的无精子症。结果患者血浆促卵泡生成素(FSH)和黄体生成素(LH)水平明显被抑制,而雄烯二酮水平则明显升高,脱氢表雄酮水平正常,睾丸CT与盆腔核磁检查提示左侧睾丸占位性病变。行保留睾丸的病灶切除术。术后病理诊断为睾丸间质细胞瘤。术后随访6个月未见肿瘤复发或转移。患者性激素水平完全恢复正常,生精功能部分恢复。术后随访第7个月,性伴侣已孕2周。结论睾丸间质细胞瘤的主要治疗措施是睾丸切除术。对于肿瘤体积较小、青春期前和双侧睾丸间质细胞瘤的患者,保留睾丸的病灶切除术也许是安全可行的。

Objective To summarize and analyze the diagnosis and treatment of Leydig cell tumor with azoospermia. Methods One case of Leydig cell tumor of testis with azoospermia was reported and the related literatures were reviewed. A 24-year-old man was referred to our hospital for infertility. Semen analyses showed strict azoospermia with normal volume. Leydig cell tumor with azoospermia are rare and to date only 3 cases were reported at home and abroad. Results Luteinizing hormone（LH） and follicle-stimulating hormone（FSH） levels were significantly suppressed, whereas androstenedione was extremely elevated. Pelvic MRI and testis CT showed a focal lesion in the left testicle. The patient was diagnosed as Leydig cell tumor with azoospermia based on clinical characteristics and examination. The patient underwent testicular tumor enucleation. Leydig cell tumor of testis was confirmed by pathological analysis after the operation. No local recurrence or distant metastasis was detected during 6 months follow-up. In the 7 months follow-up, the sexual partners had been pregnant for 2 weeks. Conclusion Testicular Leydig cell tumors associated with azoospermia are rare. Azoospermia proved to be partly reversible within less than 6 months after tumor removal and normalization of hormone levels. The therapy of LCTs is surgical, and the standard therapy is orchidectomy. Testis-sparing surgery may be feasible and effective in case of pre-mature patients, bilateral and small tumors.