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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 proliferation of Leydig cells (Loy and Linke, 2003).

Epidemiology

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.

Diagnostic Workup

Laboratory tests

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.

Staging:

If malignancy is suspected: chest X-ray (or CT scan), abdominal CT scan.

Treatment

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.

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 shows only a moderate response rate in metastatic Leydig cell tumor.

References

  Deutsche Version: Leydig-Zell Tumor des Hodens