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Leydig-Cell Tumor of the Testis

Definition

The Leydig-cell tumor is a hormone-producing stromal tumor of the testis with the proliferation of Leydig cells (Loy and Linke, 2003).

Epidemiology

1–3% of all testicular tumors, age peaks in childhood (5–10 years) and adults aged 30–60.

Pathology of the Leydig cell tumor

Small yellow-brown tumors, sharply circumscribed in the testicular tissue. Histologic evidence of malignancy includes necrosis, lymphatic vessel invasion, nuclear polymorphism, and increased mitotic activity, which are present in 10% of the cases.

Signs and Symptoms

• Nontender palpable testicular tumor
• Hormonal symptoms due to the production of testosterone are common: pubertas praecox, after puberty gynecomastia, erectile dysfunction, and decreased libido.

Diagnostic Workup

Laboratory tests

Hormone analysis :

Testosterone is often elevated and sometimes estrogen. LH and FSH tend to be suppressed. The following tests exclude (when normal) adrenal hormone production: 17-hydroxysteroid and 17-ketosteroid in urine, cortisone in plasma, ACTH stimulation, and dexamethasone suppression test.

Tumor marker of germ cell tumors:

Serum alpha-fetoprotein, beta human chorionic gonadotropin, and lactate dehydrogenase are within the normal range.

Ultrasound of the testes:

The typical finding in testicular ultrasound imaging is a well-circumscribed hypoechoic testicular mass.

Leydig cell tumor in testicular ultrasound imaging: well-circumscribed hypoechoic testicular mass.

Staging:

If malignancy is possible, perform a CT scan of the chest and abdomen.

Treatment of Leydig Cell Tumor

Surgical treatment of the testicular tumor

Radical (inguinal) orchiectomy is often the initial treatment for larger tumors. Tumor enucleation and organ preservation is possible for small tumors or preoperative suspicion of a benign tumor, but the diagnosis should be confirmed with frozen section examination. If there are signs of malignancy or evidence of germ cell tumors on frozen section, radical orchiectomy should be performed.

Retroperitoneal lymphadenectomy:

(Laparoscopic) retroperitoneal lymphadenectomy should be offered if pathology shows clear signs of malignancy or if enlarged retroperitoneal lymph nodes are present.

Chemotherapy:

Chemotherapy for metastatic Leydig cell tumor; however, the response rates are low with cisplatin-containing combination regimens.

References

Loy und Linke 2003 LOY, V. ; LINKE, J.: [Endocrine tumors of the testis].
In: Pathologe
24 (2003), Nr. 4, S. 308–13

  Deutsche Version: Leydig-Zell Tumor des Hodens