Figure 3: Leydig cell tumor in a 65-year-old male patient. The case is misdiagnosed as malignant prior to surgery. (a) Grayscale US image shows a 13-mm, regular, circumscribed margin, and hypoechoic lesion (arrowheads) in the left testis. (b) Color Doppler US image shows mixed (peripheral and central) vascularization. (c) Strain elastography image shows a mainly hard lesion (encoded blue). CEUS shows (d) homogeneous hyperenhancement during the early phase and (e) hyperenhancement during the late phase relative to the adjacent parenchyma. The arrows indicate testicular Leydig cell tumor. US: ultrasound; CEUS: contrast-enhanced US; S: soft; H: hard.