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

Resumo

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.