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Leydig-Cell Tumor of the Testis
The Leydig-cell tumor is a hormone-producing stromal tumor of the testis with proliferation of Leydig cells (Loy and Linke, 2003).
1–3% of all testicular tumors. Most common in boys (5–10 years old) and in adults aged 30–60 years.
Pathology of the Leydig cell tumor
Small yellow-brown tumors, sharply circumscribed in the testicular tissue. Signs for malignancy are necrosis, lymphovascular invasion and nuclear polymorphism and increased mitotic activity, which are present in 10% of the cases.
Signs and Symptoms
- Nontender palpable testicular tumor
- Hormonal disorders due to the production of testosterone: precocious puberty (in children). Gynecomastia, erectile dysfunction and decreased libido in male adults.
Hormone analysis :
Testosterone is usually elevated, estrogen may be increased. LH and FSH are usually suppressed.
In contrast to adrenal hormone production, the following tests are usually normal in patients with Leydig-cell tumor: 17-hydroxy and 17-ketosteroids in urine, cortisone in plasma. Adrenocorticotropic hormone stimulation test and Dexamethasone suppression test.
Tumor marker of germ cell tumors:
Serum alpha-fetoprotein, beta human chorionic gonadotropin, lactate dehydrogenase.
Ultrasound of the testes:
The typical finding in testicular ultrasound imaging is a well-circumscribed hypoechoic testicular mass.
If malignancy is suspected: chest X-ray (or CT scan), abdominal CT scan.
Surgical treatment of the testicular tumor
Radical (inguinal) orchiectomy is often the initial treatment for larger tumors. Testis-sparing surgery is possible for small tumors or if a Leydig-cell tumor is suspected: after enucleation the tumor is sent for frozen section. If malignancy is suspected (germ cell tumor or malignant leydig-cell tumor), radical orchiectomy should be done.
(Laparoscopic) retroperitoneal lymphadenectomy should be offered if pathology shows clear signs of malignancy or if enlarged retroperitoneal lymph nodes are present.
Chemotherapy shows only a moderate response rate in metastatic Leydig cell tumor.
Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z
ReferencesLoy und Linke 2003 LOY, V. ; LINKE, J.: [Endocrine tumors of the testis].
24 (2003), Nr. 4, S. 308–13
Deutsche Version: Leydig-Zell Tumor des Hodens