KEY FACTS
Terminology
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Gonadal stromal tumors arise from nongerm cell elements
Imaging
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Leydig cell tumors
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Small, solid, hypoechoic intratesticular mass
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May occasionally show cystic change
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Sertoli cell tumors
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Small, hypoechoic mass with occasional hemorrhage, which may lead to heterogeneity and cystic components
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± punctate calcification; large, calcified mass in large-cell calcifying Sertoli cell tumor
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May produce estrogen/müllerian inhibiting factor
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Gonadoblastoma
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Stromal tumor in conjunction with germ cell tumor, usually mixed sonographic features
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Clinical Issues
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30% of patients with gonadal stromal tumors have endocrinopathy secondary to testosterone or estrogen production by tumor presenting with
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Precocious virilization in children
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Gynecomastia, impotence, ↓ libido in adults
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Majority of these tumors are benign
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Orchidectomy is preferred treatment
Diagnostic Checklist
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Consider stromal tumor in any patient with endocrinopathy and testicular mass
Scanning Tips
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May be indistinguishable from germ cell tumors on grayscale ultrasound but typically smaller in size
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High-frequency transducer (9-15 MHz) best imaging tool for detection of gonadal stromal neoplasms
. The tumor is small and, like many sex cord stromal tumors, does not extensively involve the testis. Hemorrhage and necrosis are lacking.
