Ten-year indolent evolution of a Leydig cell tumor: A case report and literature review

Leydig cell tumors (LCTs) are rare sex cord-stromal neoplasms that pose diagnostic challenges due to their overlap with germ cell tumors. This report describes a 45-year-old male with a 10-year history of a slow-growing, painless testicular mass. Preoperative imaging revealed a hypervascular, hypoechoic nodule. Histopathological analysis following a radical orchiectomy confirmed a benign LCT characterized by polygonal cells with eosinophilic cytoplasm and absent mitotic activity. The case emphasizes the shift toward early detection via ultrasound and highlights the necessity of long-term surveillance to monitor the metastatic potential inherent in adult LCTs. • Reports a rare benign Leydig cell tumor in a 45-year-old asymptomatic male. • Hypervascular, hypoechoic ultrasonography features aided early tumor detection. • Histopathology confirmed pT1a staging with a distinct absence of mitotic activity. • Discusses radical orchiectomy versus the trend toward testis-sparing surgery. • Emphasizes the necessity of long-term surveillance for adult stromal neoplasms.