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Optimizing Management of Leydig Cell Tumors: 27-Year Experience of Avoiding Frozen Sections Guided by Expert
Peter Beniac1, Laetitia Lonca2, Sophie Ferlicot3
1Department of Urology, University Hospital of Bicêtre, Paris-Saclay University, Le Kremlin Bicêtre, France. peter.beniac@gmail.com.
Purpose:
Leydig cell tumors (LCTs) are rare, usually benign testicular tumors for which frozen section examination is commonly recommended during testis-sparing surgery (TSS). We report a 27-year single-center experience, emphasizing the role of imaging for conservative surgery decision-making. It shows our experience using expert radiology assessment to direct TSS without frozen section examination.
Materials And Methods:
In this retrospective observational study, we reviewed our institutional database of testicular tumors treated between 1998 and 2025. Patients with histologically confirmed LCTs were included. Clinical presentation, hormonal profile, imaging characteristics, surgery type, and intraoperative frozen section use were analyzed.
Results:
Among 481 testicular tumors, 68 (14.14%) were LCTs. Within the histologically confirmed LCTs cohort, preoperative expert radiology assessment achieved 97% (66/68) concordance with the final pathology. Partial orchiectomy was performed in 62 cases (91.18%), total orchiectomy in 6 (8.82%). Median age was 36 years. Median follow-up was 75 months. No malignant LCTs were observed. All patients remained in complete remission. The most common reasons for consultation were infertility (n=41, 60.29%) where systematic ultrasound screening discovered the lesion, gynecomastia (n=4, 5.88%), Klinefelter syndrome work-up (n=4, 5.88%; 2 additional cases identified within the infertility group, total n=6) and palpable nodule (n=4, 5.88%). Median ultrasound tumor size was 7 mm (range: 2 to 32 mm).
Conclusions:
Radiological characteristics effectively differentiated LCTs, suggesting that direct TSS without frozen section examination might be feasible when expert radiological evaluation is available. Our findings reflect radiology-pathology concordance within histologically confirmed LCTs rather than diagnostic accuracy in an unselected population. This approach optimizes surgical workflow, preserves endocrine function and fertility. No recurrence was observed. Frozen section examination should be maintained where expert radiology consultation is unavailable or diagnostic uncertainty exists. Prospective validation is required before omitting frozen section examination outside expert centers.