Efficacy of aromatase inhibitor therapy in a case with large cell calcifying Sertoli cell tumour-associated prepubertal gynaecomastia

J Pediatr Endocrinol Metab. 2022 Oct 3;35(12):1565-1570. doi: 10.1515/jpem-2022-0368. Print 2022 Dec 16.

Abstract

Objectives: Large cell calcifying Sertoli cell tumours (LCCSCTs) are one of the infrequent causes of prepubertal gynaecomastia. Most of these tumours are in the content of Peutz-Jeghers syndrome (PJS) or other familial syndromes (Carney complex).

Case presentation: Here, we report a long-term follow-up of an 8.5-year-old prepubertal boy with a diagnosis of PJS, who presented with bilateral gynaecomastia, advanced bone age and accelerated growth velocity, and were found to have bilateral multifocal testicular microcalcifications. As the findings were compatible with LCCSCT, anastrozole was initiated. Gynaecomastia completely regressed and growth velocity and pubertal development were appropriate for age during follow-up. Testicular lesions slightly increased in size. After four years of medication, anastrozole was discontinued but was restarted due to the recurrence of gynaecomastia after six months.

Conclusions: Testicular tumour should be investigated in a patient with PJS who presents with prepubertal gynaecomastia. When findings are consistent with LCCSCT, aromatase inhibitors may be preferred in the treatment.

Keywords: Peutz-jeghers syndrome; anastrozole; gynaecomastia; large-cell calcifying Sertoli cell tumour.

Publication types

  • Case Reports

MeSH terms

  • Anastrozole / therapeutic use
  • Aromatase Inhibitors / therapeutic use
  • Child
  • Gynecomastia* / drug therapy
  • Gynecomastia* / etiology
  • Humans
  • Male
  • Peutz-Jeghers Syndrome* / diagnosis
  • Sertoli Cell Tumor* / complications
  • Sertoli Cell Tumor* / drug therapy
  • Testicular Neoplasms* / complications
  • Testicular Neoplasms* / drug therapy
  • Testicular Neoplasms* / pathology

Substances

  • Aromatase Inhibitors
  • Anastrozole