Bilateral gynaecomastia – a diagnostic indicator of malignant testicular mass: case report and review of literature

Main Article Content

EU Oyibo
B Price
JM Lazarus

Abstract

Gynaecomastia is the most common benign breast disorder in men. Though uncommon, testicular malignancies are known to cause bilateral gynaecomastia. Consequently, a high index of suspicion is required when there is a coexistence of testicular mass. The case presents a 48-year-old male with a nine-month history of left testicular swelling and a history of bilateral gynaecomastia. The patient had no abnormality on clinical or biochemical examination (LDH 192 U/L [100–190], ß-hCG < 1 IU/L, α-FP < 0.6 μg/L [0.0–7.0]). Ultrasound imaging revealed a hypoechoic mass on the lower pole of the left testis, and the histology of the radical orchidectomy specimen revealed a Leydig cell tumour (LCT). This tumour histology is commonly associated with gynaecomastia and beta-human chorionic gonadotropin (ß-hCG)-secreting tumours, such as choriocarcinomas, with a strong differential diagnosis. This report underlines the importance of a clinical breast examination in patients being evaluated for a testicular mass, as this may indicate an unusual malignancy.

Article Details

Section
Case Report
Author Biographies

EU Oyibo, University of Cape Town

Division of Urology, Groote Schuur Hospital, University of Cape Town, South Africa

B Price, University of Cape Town

Division of Anatomical Pathology, Faculty of Health Sciences, University of Cape Town, South Africa

JM Lazarus, University of Cape Town

Division of Urology, Groote Schuur Hospital, University of Cape Town, South Africa