Testicular Leydig cell tumor (LCT) represents a rare but significant sex cord-stromal neoplasm often discovered during routine screenings. Although most of these tumors are benign, accurate preoperative characterization remains essential for determining the surgical approach. Clinicians now increasingly utilize advanced multimodal ultrasound to identify specific vascular patterns. Specifically, Microvascular Flow Imaging (MVFI) offers a detailed view of low-velocity blood flow without requiring contrast agents.

This case highlights the visualization of peripheral annular vascularity alongside intralesional blood flow. Consequently, these findings provide critical insights for differentiating LCT from more aggressive germ cell tumors. Traditional color Doppler imaging might miss these subtle vessels due to motion artifacts. However, MVFI employs sensitive filters to capture microvascular architecture clearly.

Diagnostic Advantages for Testicular Leydig Cell Tumor

Furthermore, real-time elastography helps assess the stiffness of the lesion, adding another layer of diagnostic data. Therefore, integrating these modalities allows for precise mapping of the tumor’s internal structure. This comprehensive imaging approach supports clinicians in selecting organ-sparing surgery over radical orchiectomy when appropriate. As a result, patients benefit from preserved fertility and improved long-term outcomes.

Frequently Asked Questions

What is the typical ultrasound appearance of a Leydig cell tumor?

A typical Leydig cell tumor appears as a small, well-defined, and homogeneously hypoechoic nodule on two-dimensional ultrasound. It often lacks calcification or cystic components compared to other testicular masses.

How does Microvascular Flow Imaging (MVFI) improve diagnostic accuracy?

MVFI identifies very low-velocity blood flow that color Doppler often misses. It specifically reveals peripheral annular vascularity and intralesional microvessels, which are characteristic findings for this tumor type.

Why is multimodal ultrasound preferred for testicular lesions?

Multimodal ultrasound combines morphology, vascularity, and stiffness data. This synergy provides a more reliable non-invasive diagnosis, helping to distinguish benign sex cord-stromal tumors from malignant germ cell neoplasms.

Disclaimer: This content is for informational and educational purposes only. It does not constitute professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Refer to the latest local and national guidelines for clinical practice.

References

Pang W et al. Multimodal Ultrasound Characterization of a Testicular Leydig Cell Tumor With Emphasis on Microvascular Flow Imaging Findings: A Case Report and Literature Review. J Clin Ultrasound. 2026 Apr 23. doi: 10.1002/jcu.70259. PMID: 42026698.

Maizlin ZV et al. Leydig cell tumors of the testis: gray scale and color Doppler sonographic appearance. J Ultrasound Med. 2004 Jul;23(7):959-64. doi: 10.7863/jum.2004.23.7.959.

Rocher L et al. Leydig Cell Tumors of the Testis: An Update of the Imaging Characteristics of a Not So Rare Lesion. MDPI. 2022 Jul 27;14(15):3692. doi: 10.3390/cancers14153692.