We reviewed four histologically confirmed cases of LCT. Clinical presentations varied: painless testicular swelling, incidental detection on imaging studies performed for other conditions, including work-up for infertility. The size of the tumour ranged from 1.8 to 3.5 cm. In all cases, AFP, β-hCG, and LDH were within normal limits preoperatively, underlining that conventional tumour markers do not play a discriminatory role here.
High-resolution scrotal ultrasound was the cornerstone of detection, but sonographic features were not pathognomonic and often overlapped with those of germ cell tumours. This diagnostic uncertainty led to all patients undergoing radical inguinal orchiectomy.
Histopathology revealed benign LCTs without necrosis, vascular invasion, or increased mitotic activity. At long-term follow-up, all patients were alive and disease-free.
Our experience emphasizes several key messages for clinical practice:
Clinical suspicion is the key: LCTs are rare, and detection depends on awareness of their various manifestations.
Appropriate surgical strategy: Although testis-sparing surgery has been suggested in selected cases, radical orchiectomy remains the safest standard when the preoperative diagnosis is uncertain.
Follow-up is important: malignant LCTs are rare, but late recurrences can occur when a seminal sparing strategy is chosen, so a structured follow-up is warranted.
The search for reliable imaging criteria or molecular biomarkers for preoperative differentiation of LCTs is an important step into the future. Co-operative registries could provide the necessary statistical power to clarify prognostic indicators and refine surgical recommendations, avoiding the risk of overtreatment.
Our results confirm that careful clinical assessment, appropriate imaging, and definitive histology remain the cornerstones of successful LCT treatment.
Written by: Rosario Leonardi,1,2 Alessandro D’angelo,3 Guglielmo Mantica,4,5 Francesca Ambrosini,4 Alessandro Calarco,6 Dorotea Sciacca,3 Gabriele Iacona,2 Dario Giuffrida3
- Department of Medicine and Surgery, University KORE of Enna, Italy
- Casa di Cura Musumeci GECAS -Gravina di Catania (CT), Italy
- IOM Istituto Oncologico del Mediterraneo – Viagrande (CT), Italy
- IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- Ospedale San Carlo di Nancy, Roma, Italy