Testis-sparing surgery for Leydig cell tumor in children: long-term results of a multicentric retrospective cohort study

Leydig cell tumors (LCTs) of the testis are rare in children. Although testis-sparing surgery (TSS) is increasingly accepted as the preferred treatment, large-scale studies with long-term follow-up remain limited. This study compared the clinical characteristics of LCTs with those of testicular teratomas and endodermal sinus tumors and evaluated the long-term outcomes of TSS in children to enhance urologists’ understanding of this condition. Patients diagnosed with LCTs between January 2015 and December 2024 at three tertiary medical centers were enrolled, along with equal numbers of patients with testicular endodermal sinus tumors and testicular teratomas as control groups. Clinical data were collected and analyzed using SPSS 22.0 software. This study enrolled 14 patients with testicular LCTs, 14 with testicular endodermal sinus tumors, and 14 with testicular teratomas. Patients with LCTs exhibited a significantly older age at presentation (P = 0.003). Precocious puberty was more prevalent in LCT patients (P < 0.001), and elevated serum testosterone levels were identified in 9 of 14 patients (64.3%). Scrotal ultrasound revealed hypoechoic masses with peripheral rim hypervascularization in LCT-affected testes, features absent in the other two groups (P < 0.001). All LCT patients underwent TSS with microscopically negative margins, and no patient experienced recurrence during follow-up (median: 42 months; range: 15–61 months). Furthermore, affected testes reached volumes comparable to those of the contralateral healthy testis within 3–4 years postoperatively. This study compares pediatric LCTs with testicular teratomas and endodermal sinus tumors to help urologists diagnose LCTs earlier and reduce misdiagnosis. The findings support TTS as an effective treatment for pediatric LCTs that preserves testicular function. Long-term follow-up using scrotal sonography and endocrine evaluation is supportive for managing pediatric LCTs.