Nagi et al 5 reported a case of primary mediastinal seminoma presenting with gynecomastia. It was suggested that hCG caused secondary leydig cell hyperplasia resulting in elevated testosterone. There was a solitary right iliac lymph node metastasis that contained hCG-producing syncytiotrophoblast. 1 The typical histology was seminoma associated with marked leydig cell hyperplasia. 4 They usually present with feminization symptoms in adults and masculinization in children.Ī unique case of human chorionic gonadotropin (hCG) –producing seminoma associated with elevated serum testosterone presenting with symptoms of androgen excess was reported by Fung et al. 1 The most common testis tumor that might cause hormonal changes and gynecomastia are leydig cell tumors, frequently recognized with high plasma estrogen, low testosterone, low testosterone/estradiol index, and low follicle stimulating hormone (FSH) or luteinizing hormone (LH) levels. 3 Seminoma, the most common GCT, is usually associated with normal serum testosterone level. High testosterone has been reported in particular cancers (ie, ovarian cancer and adrenal adenoma). Three months later, all tumor markers and testosterone level had normalized with total disappearance of gynecomastia/acne without any evidence of disease. He was upstaged to pT1N2M0 (stage IIB) and referred to undergo adjuvant chemotherapy with two cycles of bleomycin, etoposide, and cisplatin. Twelve of 34 of retroperitoneal lymph nodes had evidence of metastatic tumor. Pathology of testis tumor was mixed GCT (90% teratoma and 10% embryonal cell) without evidence of leydig cell hyperplasia. After discussion of different treatment options, the patient opted to undergo left orchiectomy and concomitant bilateral nerve-sparing retroperitoneal lymph node dissection that was performed without significant complication. There was no evidence of immunoreactivity with placental alkaline phosphatase. Retroperitoneal CT-guided biopsy showed high-grade malignant cells. Positron emission tomography–computed tomography (CT) scan revealed a 1.2-cm left para-aortic lymph node with a maximum standard uptake value of 3.6 ( Fig 1 ). Scrotal ultrasonography showed two subtle areas of hypoechogenicity in left testis (0.5 and 0.7 cm). Preoperative values are summarized in Table 1. Physical exam was normal except bilateral gynecomastia. There was no history of medication use, alcohol abuse, or medical disease. The first case is a 45-year-old man with presenting symptoms of bilateral gynecomastia, sore nipples, increased muscle mass, back acne, and increased libido.

Adrenaline secreting tumor