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Yang X, Quan LJ. Ultrasound contrast-enhanced diagnosis of testicular Leydig cell tumor: A case report and literature review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 38450802 DOI: 10.1002/jcu.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/07/2024] [Accepted: 02/10/2024] [Indexed: 03/08/2024]
Abstract
Leydig cell tumor (LCT) is a rare testicular tumor. We report a case of an elderly male patient who discovered a left testicular mass during a regular health examination four years ago. The patient did not experience any significant discomfort and opted for regular follow-up visits. During the most recent visit, we performed routine ultrasound and contrast-enhanced ultrasound (CEUS) examinations. By observing the lesion's location, echogenicity, margins, vascular distribution, as well as the rapid enhancement and slow washout characteristics on contrast-enhanced ultrasound, we arrived at a diagnosis of LCT. Subsequently, the patient underwent left inguinal orchiectomy. Postoperative pathology and immunohistochemistry confirmed the diagnosis of LCT. Additionally, we conducted a comprehensive review of LCT-related literature from PubMed and SCOPUS, summarizing the clinical features, follow-up duration, prognosis, and ultrasound characteristics associated with LCT.
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Affiliation(s)
- Xu Yang
- Department of Ultrasound, The Second People's Hospital, Jiashan County, China
| | - Li-Juan Quan
- Department of Ultrasound, The First Hospital, Jiaxing, China
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2
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Balagamage C, Arshad A, Elhassan YS, Ben Said W, Krone RE, Gleeson H, Idkowiak J. Management aspects of congenital adrenal hyperplasia during adolescence and transition to adult care. Clin Endocrinol (Oxf) 2023. [PMID: 37964596 DOI: 10.1111/cen.14992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 10/11/2023] [Accepted: 11/03/2023] [Indexed: 11/16/2023]
Abstract
The adolescent period is characterised by fundamental hormonal changes, which affect sex steroid production, cortisol metabolism and insulin sensitivity. These physiological changes have a significant impact on patients with congenital adrenal hyperplasia (CAH). An essential treatment aim across the lifespan in patients with CAH is to replace glucocorticoids sufficiently to avoid excess adrenal androgen production but equally to avoid cardiometabolic risks associated with excess glucocorticoid intake. The changes to the hormonal milieu at puberty, combined with poor adherence to medical therapy, often result in unsatisfactory control exacerbating androgen excess and increasing the risk of metabolic complications due to steroid over-replacement. With the physical and cognitive maturation of the adolescent with CAH, fertility issues and sexual function become a new focus of patient care in the paediatric clinic. This requires close surveillance for gonadal dysfunction, such as irregular periods/hirsutism or genital surgery-associated symptoms in girls and central hypogonadism or testicular adrenal rest tumours in boys. To ensure good health outcomes across the lifespan, the transition process from paediatric to adult care of patients with CAH must be planned carefully and early from the beginning of adolescence, spanning over many years into young adulthood. Its key aims are to empower the young person through education with full disclosure of their medical history, to ensure appropriate follow-up with experienced physicians and facilitate access to multispecialist teams addressing the complex needs of patients with CAH.
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Affiliation(s)
- Chamila Balagamage
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Amynta Arshad
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- The Medical School, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Yasir S Elhassan
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Wogud Ben Said
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth E Krone
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Helena Gleeson
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Jan Idkowiak
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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3
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Huang Y, Chen B, Cao D, Chen Z, Li J, Guo J, Dong Q, Wei Q, Liu L. Sex Cord-Stromal Tumors of Testis: A Clinicopathologic and Follow-Up Study of 15 Cases in a High-Volume Institute of China. Front Med (Lausanne) 2022; 9:816012. [PMID: 35712094 PMCID: PMC9197338 DOI: 10.3389/fmed.2022.816012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/21/2022] [Indexed: 02/05/2023] Open
Abstract
Objectives To report the first series of testicular sex cord-stromal tumors (TSCSTs) with detailed clinicopathologic findings and long-term follow-up in the Chinese population. Patients and Methods From 2008 to 2018, 15 patients with TSCST were included in our study. The tumors were analyzed for epidemiological parameters, clinical characteristics, tumor markers, therapy, and follow-up data. Results The median age of the patients was 28 years (range, 13–80 years). Para-aortic lymph node metastases were detected in 2 patients after radiological evaluation. Orchiectomy was performed in all patients, and the median diameter of the tumor was 1.5 cm (range, 0.5–5.0 cm). Nine Leydig cell tumors (LCTs), 5 Sertoli cell tumors (SCTs), and 1 unclassified type were confirmed after pathologic evaluation. Thirteen patients (86.7%) were categorized as stage I, and 2 patients (13.3%) were categorized as stage II. The median clinical follow-up was 39.0 months (range, 5–97 months), which showed 10 alive patients, such as 1 patient with progression at 40 months after orchiectomy. The 3- and 5-year progression-free survivals were 100 and 90.0%, respectively. Conclusion Testicular sex cord-stromal tumor at stages I and II is a rare subtype with benign behavior and a favorable prognosis in the Chinese population. However, lymph node metastases may be the dominant risk factor for patients with TSCST.
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Affiliation(s)
- Yin Huang
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China.,West China School of Medicine, Sichuan University, Chengdu, China
| | - Bo Chen
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Dehong Cao
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Zeyu Chen
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Jin Li
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Jianbing Guo
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Qiang Dong
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Qiang Wei
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
| | - Liangren Liu
- Department of Urology, West China Hospital, Institute of Urology, Sichuan University, Chengdu, China
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4
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Grand T, Hermann AL, Gérard M, Arama E, Ouerd L, Garrouche N, Rocher L. Precocious puberty related to Leydig cell testicular tumor: the diagnostic imaging keys. Eur J Med Res 2022; 27:67. [PMID: 35550623 PMCID: PMC9097322 DOI: 10.1186/s40001-022-00692-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 04/23/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND We report the challenging case of a 6-year-old boy with precocious puberty related to histologically proven Leydig cell tumor. CASE PRESENTATION Multiparametric ultrasound and magnetic resonance imaging (MRI) was performed. Interesting findings were scarcely or never reported in children and differed from adults Leydig cell tumors s such as the hyperechogenic halo surrounding the lesion and the dominant central vascularization using ultrasensitive Doppler. MRI revealed an enlarged testicle with strong enhancement of a tumor, a tumor apparent diffusion coefficient (ADC) of 600 × 10-3 mm2/s and a lower ADC value of the non-tumor parenchyma compared to the contralateral testis (ADC = 800 × 10-3 mm2/s vs 1100 × 10-3 mm2/s), attributed to the spermatogenesis induced by hormonal impregnation. CONCLUSION We illustrate multiparametric US and MRI findings of a pediatric Leydig cell tumor, including the imaging changes attributed to local hormone secretion, which may be helpful in similar cases.
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Affiliation(s)
- Téodor Grand
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, 157 rue de la porte de trivaux, 92140, Clamart, France
| | | | - Maxime Gérard
- Service de Pédiatrie, Armand Trousseau Hospital, Paris, France
| | - Emmanuel Arama
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, 157 rue de la porte de trivaux, 92140, Clamart, France
- Université Paris Saclay, 63 rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France
| | - Linda Ouerd
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, 157 rue de la porte de trivaux, 92140, Clamart, France
| | - Nada Garrouche
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, 157 rue de la porte de trivaux, 92140, Clamart, France
| | - Laurence Rocher
- Service de Radiologie, APHP Hôpitaux Paris Saclay, Hôpital Antoine Béclère, 157 rue de la porte de trivaux, 92140, Clamart, France.
- Université Paris Saclay, 63 rue Gabriel Péri, 94270, Le Kremlin-Bicêtre, France.
- BIOMAPS, IR4M, UMR8081, 4, place du Général Leclerc, 91401, Orsay cedex, France.
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5
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Osaka A, Ide H, Matsuoka K, Iwahata T, Kobori Y, Ban S, Okada H, Saito K. SRY-Positive 46, XX Testicular Disorder of Sexual Development With Leydig Cell Tumor. Am J Mens Health 2020; 14:1557988320970071. [PMID: 33131361 PMCID: PMC7607790 DOI: 10.1177/1557988320970071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The risk of a gonadal tumor is high in testicular disorder of sexual development (DSD) with the Y chromosome, but cases of DSD without the Y chromosome are extremely rare. We reported a gonadal tumor in a phenotypically male individual with 46, XX testicular DSD. A testicular tumor was incidentally found in a 32-year-old phenotypic male who was presented to the hospital with male infertility. A diagnosis of 46, XX testicular DSD was made by the presentation of karyotype analysis of 46, XX with the sex-determining region of the Y chromosome (SRY) positive and gonadal tissue without female gonads. Surgery was performed due to a gradually growing tumor. The partial orchidectomy was performed with the diagnosis of a benign Leydig cell tumor in frozen biopsy.
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Affiliation(s)
- Akiyoshi Osaka
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hisamitsu Ide
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kentaro Matsuoka
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Toshiyuki Iwahata
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Yoshitomo Kobori
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Shinichi Ban
- Department of Pathology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Hiroshi Okada
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
| | - Kazutaka Saito
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Saitama, Japan
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Colecchia M, Bertolotti A, Paolini B, Giunchi F, Necchi A, Paganoni AM, Ricci C, Fiorentino M, Dagrada GP. The Leydig cell tumour Scaled Score (LeSS): a method to distinguish benign from malignant cases, with additional correlation with MDM2 and CDK4 amplification. Histopathology 2020; 78:290-299. [PMID: 32757426 DOI: 10.1111/his.14225] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/01/2020] [Indexed: 01/22/2023]
Abstract
AIMS To investigate the morphological and molecular characteristics of Leydig cell tumours (LCTs) of the testis for the identification of cases that may metastasise. METHODS AND RESULTS Six parameters for a predictive model of the metastatic risk were evaluated in 37 benign and 14 malignant LCTs of the testis [LCT Scaled Score (LeSS)]. The tumour size (benign LCTs, mean 13.3 mm; malignant LCTs, mean 44 mm) (P < 0.001) and five other parameters (infiltrative margins, necrosis, vascular invasion, mitotic count, and nuclear atypia) showed significant differences (Wilcoxon's test, P < 0.001). Eight metastatic LCTs and one benign LCT had infiltrative margins. Foci of coagulative necrosis occurred in 10 metastatic LCTs, whereas vascular invasion was identified in nine of 14 metastatic LCTs and none of 37 benign LCTs. Benign LCTs showed <2 mitoses/10 high-power fields (HPFs), whereas a high mitotic count (range, 3-50 mitoses/10 HPFs) was a feature of malignant LCTs. These parameters were selected by use of an inferential analysis based on univariate logistic regression models to develop a score. A LeSS of <4 correctly identified all histologically and clinically benign LCTs. A LeSS of ≥4 correctly identified all malignant LCTs. MDM2 and CDK4 immunostains were applied in all 51 cases: benign LCTs were negative; three of 11 malignant LCTs (27%) showed strong and diffuse immunopositivity and high levels of MDM2 and CDK4 amplification as determined with fluorescence in-situ hybridisation analysis and next-generation sequencing. CONCLUSION We provide a new tool, the LeSS, for the prediction of malignant behaviour in LCTs.
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Affiliation(s)
- Maurizio Colecchia
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Alessia Bertolotti
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Biagio Paolini
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Francesca Giunchi
- Department of Pathology, Ospedale Maggiore and University of Bologna, Bologna, Italy
| | - Andrea Necchi
- Department of Medical Oncology, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
| | - Anna M Paganoni
- Department of Mathematics, MOX-Modelling and Scientific Computing, Politecnico di Milano, Politecnico di Milano, Milan, Italy
| | - Costantino Ricci
- Department of Pathology, Ospedale Maggiore and University of Bologna, Bologna, Italy
| | | | - Gian P Dagrada
- Department of Diagnostic Pathology and Laboratory Medicine, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milan, Italy
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7
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Bilateral Leydig Cell Tumors in Klinefelter Patient: A Case Report. Urology 2020; 142:e29-e31. [PMID: 32305546 DOI: 10.1016/j.urology.2020.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022]
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8
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Nakane Y, Kemmochi Y, Ogawa N, Sasase T, Ohta T, Higami Y, Fukai F. Hyperglycemia contributes to the development of Leydig cell hyperplasia in male Spontaneously Diabetic Torii rats. J Toxicol Pathol 2020; 33:121-129. [PMID: 32425345 PMCID: PMC7218238 DOI: 10.1293/tox.2019-0088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 01/27/2020] [Indexed: 12/11/2022] Open
Abstract
Spontaneously Diabetic Torii (SDT) rats are a well-known animal model of non-obese type 2 diabetes mellitus. Although this animal model has been studied extensively over the last decade, the incidence rates of Leydig cell hyperplasia and tumors in this model have not been reported. In this study, pathophysiological analyses of the testes were performed on male SDT rats, to understand the effect of insulin treatment on the development of Leydig cell hyperplasia and tumors and the expression of integrins and extracellular matrix proteins. Testicular Leydig cell hyperplasia and tumors were observed in SDT rats at 64 weeks of age but were rarely identified in Sprague-Dawley (SD) rats of the same age. Insulin treatment decreased plasma glucose and HbA1c levels, and interestingly, decreased the number of hyperplastic Leydig cell foci and Leydig cell tumors in treated animals. A similar reduction in the expression of Ki67 in these Leydig cell foci was also observed. In addition, insulin treatment decreased the expression of integrin α5, integrin β1, integrin αvβ3, fibronectin, and vitronectin in hyperplastic Leydig cell foci. These results suggest that insulin might decrease the incidence of Leydig cell hyperplasia by reducing Leydig cell proliferation and the expression of integrins and extracellular matrix proteins through the reduction of serum glucose concentrations in these animals.
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Affiliation(s)
- Yoshitomi Nakane
- Japan Tobacco Inc., Central Pharmaceutical Research Institute, 1-1 Murasaki-cho, Takatsuki, Osaka 569-1125, Japan.,Laboratory of Molecular Pathology and Metabolic Disease, Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan.,Laboratory of Molecular Pathophysiology, Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan
| | - Yusuke Kemmochi
- Japan Tobacco Inc., Central Pharmaceutical Research Institute, 1-1 Murasaki-cho, Takatsuki, Osaka 569-1125, Japan
| | - Naoto Ogawa
- Japan Tobacco Inc., Central Pharmaceutical Research Institute, 1-1 Murasaki-cho, Takatsuki, Osaka 569-1125, Japan
| | - Tomohiko Sasase
- Japan Tobacco Inc., Central Pharmaceutical Research Institute, 1-1 Murasaki-cho, Takatsuki, Osaka 569-1125, Japan
| | - Takeshi Ohta
- Laboratory of Animal Physiology and Functional Anatomy, Graduate School of Kyoto University, Kitashirakawaoiwake-cho, Sakyo-ku, Kyoto-shi, Kyoto 606-8502, Japan
| | - Yoshikazu Higami
- Laboratory of Molecular Pathology and Metabolic Disease, Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan
| | - Fumio Fukai
- Laboratory of Molecular Pathophysiology, Faculty of Pharmaceutical Sciences, Tokyo University of Science, 2641 Yamazaki, Noda, Chiba 278-8510, Japan
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9
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Ruf CG, Sanatgar N, Isbarn H, Ruf B, Simon J, Fankhauser CD, Dieckmann KP. Leydig-cell tumour of the testis: retrospective analysis of clinical and therapeutic features in 204 cases. World J Urol 2020; 38:2857-2862. [DOI: 10.1007/s00345-020-03079-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/03/2020] [Indexed: 11/24/2022] Open
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10
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Zu'bi F, Koyle MA, Rickard M, Beaiti M, Kahn N, Blais AS, Hannick JH, Lopes RI, Lorenzo AJ. Testis-sparing Surgery for Pediatric Leydig Cell Tumors: Evidence of Favorable Outcomes Irrespective of Surgical Margins. Urology 2019; 134:203-208. [DOI: 10.1016/j.urology.2019.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/07/2019] [Accepted: 09/16/2019] [Indexed: 01/08/2023]
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11
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Gorowska-Wojtowicz E, Duliban M, Kudrycka M, Dutka P, Pawlicki P, Milon A, Zarzycka M, Placha W, Kotula-Balak M, Ptak A, Wolski JK, Bilinska B. Leydig cell tumorigenesis - implication of G-protein coupled membrane estrogen receptor, peroxisome proliferator-activated receptor and xenoestrogen exposure. In vivo and in vitro appraisal. Tissue Cell 2019; 61:51-60. [PMID: 31759407 DOI: 10.1016/j.tice.2019.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 12/29/2022]
Abstract
The etiology and molecular characteristics of Leydig cell tumor (LCT) are scarcely known. From the research data stems that estrogen can be implicated in LCT induction and development, however it is not investigated in detail. Considering the above, herein we analyzed the relation between G-protein coupled membrane estrogen receptor, peroxisome proliferator-activated receptor and insulin-like family peptides (insulin-like 3 peptide; INSL3 and relaxin; RLN) expressions as well as estrogen level with impact of xenoestrogen (bisphenol A; BPA, tetrabromobisphenol A; TBBPA, and tetrachlorobisphenol A; TCBPA). While in our previous studies altered GPER-PPAR partnership was found in human LCT being a possible cause and/or additionally effecting on LCT development, here mouse testes with experimentally induced LCT and mouse tumor Leydig cell (MA-10) treated with BPA chemicals were examined. We revealed either diverse changes in expression or co-expression of GPER and PPAR in mouse LCT as well as in MA-10 cells after BPA analogues when compared to human LCT. Relationships between expression of INSL3, RLN, including co-expression, and estrogen level in human LCT, mouse LCT and MA-10 cells xenoestrogen-treated were found. Moreover, involvement of PI3K-Akt-mTOR pathway or only mTOR in the interactions of examined receptors and hormones was showed. Taken together, species, cell of origin, experimental system used and type of used chemical differences may result in diverse molecular characteristics of LCT. Estrogen/xenoestrogen may play a role in tumor Leydig cell proliferation and biochemical nature but this issue requires further studies. Experimentally-induced LCT in mouse testis and MA-10 cells after BPA exposure seem to be additional models for understanding some aspects of human LCT biology.
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Affiliation(s)
- E Gorowska-Wojtowicz
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland.
| | - M Duliban
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - M Kudrycka
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - P Dutka
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - P Pawlicki
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - A Milon
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - M Zarzycka
- Chair of Medical Biochemistry Jagiellonian University Medical College, Kopernika 7, 31-034, Krakow, Poland
| | - W Placha
- Chair of Medical Biochemistry Jagiellonian University Medical College, Kopernika 7, 31-034, Krakow, Poland
| | - M Kotula-Balak
- University Centre of Veterinary Medicine, University of Agriculture in Krakow, Mickiewicza 24/28, 30-059, Krakow, Poland
| | - A Ptak
- Department of Physiology and Toxicology of Reproduction, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
| | - J K Wolski
- nOvum Fertility Clinic, Bociania 13, 02-807 Warszawa, Poland
| | - B Bilinska
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Kraków, Gronostajowa 9, 30-387 Krakow, Poland
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12
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García González M, Casal-Beloy I, Somoza Argibay I, Dargallo Carbonell T. Atypical presentation of Leydig cell tumour in three prepubertal patients: diagnosis, treatment and outcomes. J Pediatr Endocrinol Metab 2019; 32:369-374. [PMID: 30875329 DOI: 10.1515/jpem-2018-0467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/30/2019] [Indexed: 11/15/2022]
Abstract
Background Testicular tumours are uncommon in children, accounting for only 1% of all childhood tumours. Prepubertal Leydig cell tumours actively secrete testosterone and as a result, patients typically present with isosexual precocious pseudopuberty, this being the first cause of consultation. We present three cases of Leydig cell tumours in prepubertal patients with an atypical presentation. Methods We studied three cases of Leydig cell tumours in prepubertal boys, who either consulted for testicular asymmetry or were incidentally found to have the tumour in the absence of systemic signs of systemic hyperandrogenism or precocious puberty. In all cases, a well-circumscribed testicular mass was found by testicular ultrasound. The diagnosis was confirmed by histology. In all three cases, testicular enucleation was performed with satisfactory follow-up. Results Following the surgical procedure, during the follow-up, all patients showed a normal testicular volume in comparison with the contralateral testis. No complications were seen during follow-up. Conclusions A testicular ultrasound in children developing asymptomatic testicular asymmetry might be recommended due to its possible hormonal action locally. An early testicular ultrasound, testicular swelling discrepancies, tumour size and androgen production are key factors in the prognosis and management of this type of tumour.
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Affiliation(s)
- Miriam García González
- Department of Paediatric Surgery, Section of Paediatric Urology, Hospital Materno-Infantil Teresa Herrera, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Isabel Casal-Beloy
- Department of Paediatric Surgery, Section of Paediatric Urology, Hospital Materno-Infantil Teresa Herrera, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Iván Somoza Argibay
- Department of Paediatric Surgery, Section of Paediatric Urology, Hospital Materno-Infantil Teresa Herrera, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
| | - Teresa Dargallo Carbonell
- Department of Paediatric Surgery, Section of Paediatric Urology, Hospital Materno-Infantil Teresa Herrera, Complexo Hospitalario Universitario de A Coruña (CHUAC), A Coruña, Spain
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13
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Calaway AC, Tachibana I, Masterson TA, Foster RS, Einhorn LH, Cary C. Oncologic Outcomes Following Surgical Management of Clinical Stage II Sex Cord Stromal Tumors. Urology 2019; 127:74-79. [PMID: 30807775 DOI: 10.1016/j.urology.2019.02.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 02/09/2019] [Accepted: 02/15/2019] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To investigate the clinical history of patients with clinical stage II sex cord stromal tumors who underwent retroperitoneal lymph node dissection (RPLND) at our institution. METHODS Our prospectively maintained testicular cancer database was queried to identify patients who presented with or developed clinical stage II sex cord stromal tumors and underwent RPLND at our institution between 1980 and 2018. Demographic, clinical, and pathologic characteristics were reviewed. Kaplan-Meier curves were graphed to assess recurrence-free and overall survival. RESULTS Fourteen patients were included in the study with a median age of 44.2years. Four patients presented with clinical stage II disease and 10 patients developed metastatic disease during follow-up of initial clinical stage I disease with a median time to metastasis of 2.7years (range: 0.4-19.5 years). Of the 10 patients with orchiectomy pathology data available, all patients had at least 1 risk factor on testis pathology (mean: 2.9 risk factors). Nine patients received treatment prior to referral to our institution. All patients recurred post-RPLND at Indiana University. Median recurrence-free survival was 9.8 months. Twelve patients died of disease with a median overall survival of 14.4 months. CONCLUSION Metastatic sex cord stromal tumors are rare and are more resistant to standard treatment modalities than metastatic germ cell tumors. Patients presenting with sex cord stromal tumors should consider prophylactic primary RPLND in the setting of 1 or more pathologic predictor of malignancy.
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Affiliation(s)
- Adam C Calaway
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN.
| | - Isamu Tachibana
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Timothy A Masterson
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Richard S Foster
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
| | - Lawrence H Einhorn
- Indiana University School of Medicine, Department of Oncology, Indianapolis, IN
| | - Clint Cary
- Indiana University School of Medicine, Department of Urology, Indianapolis, IN
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Two Years of Gynecomastia Caused by Leydig Cell Tumor. Case Rep Urol 2018; 2018:7202560. [PMID: 30112247 PMCID: PMC6077527 DOI: 10.1155/2018/7202560] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 07/12/2018] [Indexed: 12/31/2022] Open
Abstract
Gynecomastia is a common incidental finding in males that can be caused by various benign or malignant diseases. In rare cases, it results from Leydig cell tumors, a rare entity accounting for 3% of all testicular neoplasms. Some of them are hormonally active but seldom cause symptomatic endocrine disturbance. Here we report on a 32-year-old male presenting with gynecomastia which he had already been suffering from for two years. Although he had been seen by three other specialists, including a urologist, none of them found the small mass in the upper pole of his right testis. We decided to perform testis-sparing surgery which confirmed the diagnosis of a hormonally active Leydig cell tumor. During follow-up, hormonal status normalized, and gynecomastia began to resolve.
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Abstract
RATIONALE Testicular Leydig cell tumor (LCT) is a rare neoplasm. It commonly presents as a painless testicular mass with or without endocrine changes. Histological and immunohistochemical examination play important roles in differentiating LCT from testicular germ cell tumors. PATIENT CONCERNS We highlight the imaging phenotype, as well as the pathological findings of a case of LCT in a 62-year-old male. DIAGNOSES Preoperative noncontrast CT scan of the abdomen revealed a 7.0 × 6.4 × 5.3 cm oval mass with heterogeneous density, located in the right testis. Pelvic noncontrast MRI showed a heterogeneous mass on T1-weighted and T2-weighted images. The solid part of the tumor exhibited high signal on the diffusion-weighted imaging, and an obvious enhancement on the contrast-enhanced MR imaging. Ultrasonography examination demonstrated a large mixed echogenic space occupying lesion involving the whole right testis with multiple cystic areas and increased vascularity. This patient underwent radical orchiectomy. The pathologic diagnosis was LCT. INTERVENTIONS This patient underwent operative resection of the tumor. Due to the negative resection margins and absence of distant metastases, the patient did not receive additional radiotherapy or chemotherapy. OUTCOMES Four months after the surgery, the follow-up CT-scan did not reveal any local recurrence and distant metastases. LESSONS This case improves our ability to detect and diagnose LCT by summarizing its imaging characteristics as well as reviewing the literature. Additionally, we described the state-of-the-art management of the management of this rare tumor.
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Affiliation(s)
- Jianguo Zhu
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University
| | - Yun Luan
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Haige Li
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University
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16
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Yuh LM, Lara PN, Wagenaar RM, Evans CP, Dall'era MA, Cress R, Yap SA. A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome. Can Urol Assoc J 2018; 11:E344-E349. [PMID: 29382456 DOI: 10.5489/cuaj.4402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We aimed to characterize demographic distribution, patient outcomes, and prognostic features of testicular sex cord stromal tumours (SCST) using a large statewide database. METHODS Adult male patients diagnosed with SCST between 1988 and 2010 were identified within the California Cancer Registry (CCR). Baseline demographic variables and disease characteristics were reported. Primary outcome measures were cancer-specific survival (CSS) and overall survival (OS). Bivariate and multivariate Cox proportional hazards models were employed to identify predictors of survival. RESULTS A total of 67 patients with SCST were identified, of which 45 (67%) had Leydig cell and 19 (28%) had Sertoli cell tumours. Median age was 40 years and the majority of patients (84%) presented with localized disease. Following orchiectomy, nine patients (15%) underwent retroperitoneal lymph node dissection (RPLND), whereas 54 patients (80%) had no further treatment. With a median followup of 75 months, two-year OS and CSS was 91% and 95%, respectively, for those presenting with stage I disease. For those presenting with stage II disease, two-year OS and CSS was 30%. Predictors of worse OS included age >60 (hazard ratio [HR] 5.64; p<0.01) and metastatic disease (HR 8.56; p<0.01). Presentation with metastatic disease was the only variable associated with worse CSS (HR 13.36; p<0.01). Histology was not found to be a significant predictor of either CSS or OS. CONCLUSIONS We present the largest reported series to date for this rare tumour and provide contemporary epidemiological and treatment data. The primary driver of prognosis in patients with SCST is disease stage, emphasizing the importance of early detection and intervention.
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Affiliation(s)
- Lindsay M Yuh
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Primo N Lara
- Division of Hematology Oncology, Department of Internal Medicine, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Rebecca M Wagenaar
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Christopher P Evans
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Marc A Dall'era
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Rosemary Cress
- Cancer Registry of Greater California, Public Health Institute, Sacramento, CA; United States.,Department of Public Health Sciences, UC Davis School of Medicine, Davis, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States
| | - Stanley A Yap
- Department of Urology, University of California Davis, Sacramento, CA; United States.,University of California Davis Comprehensive Cancer Center, Sacramento, CA; United States.,Division of Urology, Department of Surgery, VA Northern California Health Care System, Sacramento, CA; United States
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17
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Laclergerie F, Mouillet G, Frontczak A, Balssa L, Eschwege P, Saussine C, Larré S, Cormier L, Vuillemin AT, Kleinclauss F. Testicle-sparing surgery versus radical orchiectomy in the management of Leydig cell tumors: results from a multicenter study. World J Urol 2017; 36:427-433. [PMID: 29230496 DOI: 10.1007/s00345-017-2151-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/04/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To compare the oncological outcomes of testicle-sparing surgery (TSS) and radical orchiectomy (RO) in patients with Leydig cell tumor (LCT) of the testis. PATIENTS AND METHODS A multicenter retrospective clinical study was conducted in 12 centers in France. All the patients with histologically proven LCT were included and analyzed according to treatment (organ-sparing surgery or radical orchiectomy). Patients underwent preoperative clinical, biological and imaging assessment. Demographic, clinical, and pathological variables were collected at baseline and compared between groups according to surgical treatment. Follow-up was calculated using the reverse Kaplan-Meier estimation and was updated at the end of 2015. RESULTS Between 1986 and 2014, 56 patients presented with LCT were identified and included in the study. Twenty-one patients (37.5%) underwent TSS and 35 (62.5%) RO. Demographics and tumor characteristics were not significantly different between the groups. Median follow-up was 62 months after TSS, but only 35 months after RO. Two patients (9.5%) developed local recurrence 15 and 34 months after TSS and underwent secondary RO. No local recurrence or metastasis was observed after complementary treatment. No recurrence was observed after RO. Disease-free survival did not differ between the groups (95.2% in TSS versus 77.1% in the RO group, p = 0.23). No patient died in the TSS group, but three patients (8.6%) in the RO group died from other diseases without evidence of relapse. One patient (4.8%) in the TSS group versus five (14.3%) in the RO group were lost to follow-up. CONCLUSION Long-term follow-up suggests that testicle-sparing surgery does not compromise relapse-free survival in the treatment of Leydig cell tumor of the testis.
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Affiliation(s)
- Florian Laclergerie
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France.,University of Burgundy Franche-Comté, 25000, Besancon, France
| | - Guillaume Mouillet
- Department of Medical Oncology, University Hospital of Besancon, 25000, Besancon, France
| | - Alexandre Frontczak
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France.,University of Burgundy Franche-Comté, 25000, Besancon, France
| | - Loïc Balssa
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France.,University of Burgundy Franche-Comté, 25000, Besancon, France
| | - Pascal Eschwege
- Department of Urology, University Hospital of Nancy, 54000, Nancy, France
| | - Christian Saussine
- Department of Urology, University Hospital of Strasbourg, 67000, Strasbourg, France
| | - Stéphane Larré
- Department of Urology, University Hospital of Reims, 51000, Reims, France
| | - Luc Cormier
- Department of Urology, University Hospital of Dijon, 21000, Dijon, France
| | - Antoine Thiery Vuillemin
- University of Burgundy Franche-Comté, 25000, Besancon, France.,Department of Medical Oncology, University Hospital of Besancon, 25000, Besancon, France.,INSERM, UMR 1098, Besancon, France
| | - François Kleinclauss
- Department of Urology and Renal Transplantation, University Hospital of Besancon, 3 Boulevard Fleming, 25000, Besancon, France. .,University of Burgundy Franche-Comté, 25000, Besancon, France. .,INSERM, UMR 1098, Besancon, France.
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18
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The natural history of Leydig cell testicular tumours: an analysis of the National Cancer Registry. Ir J Med Sci 2017; 187:323-326. [PMID: 28726031 DOI: 10.1007/s11845-017-1662-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 07/07/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Leydig cell tumour (LCT) of the testis is a rare histological subtype of stromal tumours, accounting for 1 to 3% of testicular neoplasms. The natural history of LCT is poorly understood. AIMS The aim of this study was to assess the incidence and natural history of Leydig cell tumours (LCT) of the testes. METHODS A search of the National Cancer Registry of Ireland database was performed regarding Leydig cell testicular tumours. Recurrence free survival (RFS) and disease-specific survival (DSS) were analysed. RESULTS Between 1994 and 2013, 2755 new cases of testicular cancer were diagnosed in Ireland. Of these, 22 (0.79%) were Leydig cell tumours. Nineteen were invasive (stage T1) and three were in situ (stage Tis). One patient developed a local recurrence following an organ preserving procedure and underwent a completion orchidectomy 107 days after initial diagnosis. No further treatment was required. There have been no disease-specific deaths. The 1-, 3- and 5-year overall survival (OS) rates were 95.5, 88.2 and 73.3%, respectively. The 5-year disease-specific survival (DSS) was 100% and the 5-year recurrence free survival (RFS) was 93.3%. CONCLUSION From the National Cancer Registry, LCT has been shown to be a rare subtype of testicular tumour. Due to the relatively favourable natural history, it may be possible to tailor less aggressive surveillance regimens in these patients.
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Bozzini G, Ratti D, Carmignani L. Treatment of leydig cell tumours of the testis: Can testis-sparing surgery replace radical orchidectomy? Results of a systematic review. Actas Urol Esp 2017; 41:146-154. [PMID: 27890492 DOI: 10.1016/j.acuro.2016.04.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/14/2016] [Indexed: 11/25/2022]
Abstract
INTRODUCTION The gold standard for Leydig cell tumours (LCTs) is still considered radical orchidectomy, but testis sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results. ACQUISITION OF EVIDENCE Studies were identified by searching electronic databases. A bibliographic search covering the period from January 1980 to December 2012 was conducted using PubMed/MEDLINE and EMBASE database. Studies were excluded if they were single case reports, meeting abstracts and conference proceedings. SYNTHESIS OF EVIDENCE The present analysis is based on a total of 13 studies that fulfilled the predefined inclusion criteria. A total of 247 participants were included in the 13 studies examined in this systematic review. 145 were treated with radical orchiectomy and 102 with TSS. In the radical surgery group, the follow-up varied from 6 to 249 months). In the TSS group, the follow-up varied from 6 to 192 months. Frozen section was performed in a total of 96 patients. Sensitivity was 87.5%. None of the patients treated with TSS presented a metastatic recurrence, while in patients treated with radical orchiectomy three patients presented with metastatic recurrence In selected cases radical surgery appears excessive and the potential for a shift to TSS as the standard management is gathering momentum. CONCLUSIONS The results confirm the favourable course of LCT treated with TSS. The results obtained are encouraging and the concept is attractive to become the standard therapy in all patients and not only in people affected by (sub)fertility or with solitary testis.
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20
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Rove KO, Maroni PD, Cost CR, Fairclough DL, Giannarini G, Harris AK, Schultz KAP, Cost NG. Pathologic Risk Factors for Metastatic Disease in Postpubertal Patients With Clinical Stage I Testicular Stromal Tumors. Urology 2016; 97:138-144. [DOI: 10.1016/j.urology.2016.06.066] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 06/02/2016] [Accepted: 06/08/2016] [Indexed: 11/26/2022]
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Maronpot RR, Nyska A, Foreman JE, Ramot Y. The legacy of the F344 rat as a cancer bioassay model (a retrospective summary of three common F344 rat neoplasms). Crit Rev Toxicol 2016; 46:641-75. [PMID: 27278595 PMCID: PMC5020328 DOI: 10.1080/10408444.2016.1174669] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The Fischer 344 (F344) rat was used by the National Toxicology Program (NTP) for over 5 decades for toxicity and carcinogenicity studies. However, in 2006, the NTP decided to switch to a different rat stock due largely to high background control incidences of Leydig cell tumors (LCTs) and mononuclear cell leukemia (MNCL), also known as large granular lymphocytic (LGL) leukemia. In the current review, we aim (1) to provide a summary of NTP bioassays with treatment-associated effects involving MNCL and LCTs in addition to male F344-specific tunica vaginalis mesothelioma (TVM); (2) to describe important pathobiological differences between these F344 rat tumor responses and similar target tissue-tumor response in humans; and (3) to present the NTP reasons for switching away from the F344 rat. We show that due to the highly variable background incidence of F344 MNCL, more reliance on historical control data than is usual for most tumor responses is warranted to evaluate potential effect of any chemical treatment in this rat strain. The high spontaneous incidence of LCTs in the testes of male F344 rats has made this tumor endpoint of little practical use in identifying potential testicular carcinogenic responses. TVM responses in F344 rats have a biological plausible relationship to LCTs unlike TVM in humans. Given their high spontaneous background incidence and species-specific biology, we contend that MNCL and LCT, along with TVM responses, in F344 rat carcinogenicity studies are inappropriate tumor types for human health risk assessment and lack relevance in predicting human carcinogenicity.
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Affiliation(s)
| | - Abraham Nyska
- b Sackler School of Medicine, Tel Aviv University, and Consultant in Toxicologic Pathology , Timrat , Israel
| | | | - Yuval Ramot
- d Hadassah-Hebrew University Medical Center , Jerusalem , Israel
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22
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Maxwell F, Izard V, Ferlicot S, Rachas A, Correas JM, Benoit G, Bellin MF, Rocher L. Colour Doppler and ultrasound characteristics of testicular Leydig cell tumours. Br J Radiol 2016; 89:20160089. [PMID: 27072392 DOI: 10.1259/bjr.20160089] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To assess the colour Doppler and ultrasound features of testicular Leydig cell tumours (LCTs) in a population of 38 surgically proven lesions. METHODS From August 2008 to March 2015, we retrospectively included 38 surgically proven LCTs in 36 patients. Clinical data, scrotal colour Doppler, B-mode ultrasound and videos images were reviewed for each patient. The volume, echotexture of the testis, size, shape, echogenicity and the vascularization pattern of the lesion were evaluated. The tumour margins were categorized as either smooth or lobulated. The vascularization was classified as intense, moderate or without any hypervascularization. We defined the vascularization pattern groups as central, peripheral and mixed (the latter meaning both central and peripheral). RESULTS 26 patients were referred for infertility [5 patients were subsequently diagnosed with Klinefelter syndrome (KS) and 5 patients with cryptorchidism]. 28 patients underwent testis-sparing surgery, while 8 patients underwent a radical orchiectomy. The LCTs were mostly infracentimetric (68.4%), with a median size of 7.0 mm (ranging from 4.0 to 11 mm). 50% of the lesions had lobulated margins, and these were significantly larger than the smooth lesions (p < 0.05). The content of the lesions was markedly homogeneous and hypoechoic. All lesions had sharp demarcations from the adjacent pulp. 36/38 lesions exhibited moderate-to-intense hypervascularization, with a mixed intrinsic and peripheral rim pattern. Larger lesions were more hypervascularized (p < 0.05). LCTs in patients with KS had atypical features. CONCLUSION Typical sporadic LCTs appeared as isolated hypoechoic, infracentimetric masses, with a clear demarcation from the adjacent pulp. They presented intrinsic and peripheral rim hypervascularization. ADVANCES IN KNOWLEDGE By undertaking the largest imaging series of LCT to date (to our knowledge), we reassessed the typical sonographical aspects of LCTs, so as to provide guidance in regard to opting for testis-sparing surgery and for follow-up. LCTs present both intrinsic and rim vascularization detectable by colour Doppler ultrasound. Intrinsic vascularization and lobulated margins are common findings in testicular LCTs.
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Affiliation(s)
- Florian Maxwell
- 1 Department of Radiology, Bicêtre University Hospital, Paris, France
| | - Vincent Izard
- 2 Department of Urology, Bicêtre University Hospital, Paris, France
| | - Sophie Ferlicot
- 3 Department of Pathology, Bicêtre University Hospital, Paris, France
| | - Antoine Rachas
- 4 Department of Public Health and Epidemiology, Bicêtre University Hospital, Paris, France
| | | | - Gérard Benoit
- 2 Department of Urology, Bicêtre University Hospital, Paris, France
| | | | - Laurence Rocher
- 1 Department of Radiology, Bicêtre University Hospital, Paris, France
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Pathologic Risk Factors in Pediatric and Adolescent Patients With Clinical Stage I Testicular Stromal Tumors. J Pediatr Hematol Oncol 2015; 37:e441-6. [PMID: 26479987 DOI: 10.1097/mph.0000000000000445] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Testicular stromal tumors (TSTs) are rare. In adult men with TSTs, various pathologic risk factors have been identified in patients with clinically localized disease that increase the risk of occult metastatic disease (OMD). We systematically reviewed existing literature to analyze the impact of these risk factors on OMD in prepubertal (0 to 12 y) and postpubertal (13 to 21 y) patients. METHODS A literature search was conducted using the combination of terms: "testicular stromal tumors," "testicular leydig cell tumors," "testicular sertoli tumors," "testicular interstitial tumors," "testicular granulosa tumor," and "testicular sex cord tumors." Studies of patients 0 to 21 years with clinical stage I TSTs were included. RESULTS A total of 100 patients from 31 publications were included with a median age at diagnosis of 5.7 years (range, 1.2 mo to 21 y). Seventy-nine patients were 12 years and below (median 7.2 mo) and 21 patients were 13 to 21 years (median 16 y). No patients in either group were identified to have OMD at retroperitoneal lymph node dissection or during follow-up surveillance (median follow-up 45.6 y; range, 4 to 360 mo). 99% of those 12 years and below versus 95% of those above 12 years had 0 to 1 pathologic risk factors, and 1% versus 5% had 2+ pathologic risk factors (P=0.38). CONCLUSIONS Clinical stage I TSTs in adolescent, postpubertal patients appear to behave in a benign manner with few pathologic risk factors, similar to prepubertal patients. Given the low risk of relapse in this population, low-impact surveillance strategies are paramount. Prospective study of these patients is needed, and entry into a tumor registry such as the International Ovarian and Testicular Stromal Tumor Registry is important to learning more about this rare disease.
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Maqdasy S, Bogenmann L, Batisse-Lignier M, Roche B, Franck F, Desbiez F, Tauveron I. Leydig cell tumor in a patient with 49,XXXXY karyotype: a review of literature. Reprod Biol Endocrinol 2015; 13:72. [PMID: 26160035 PMCID: PMC4496935 DOI: 10.1186/s12958-015-0071-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/30/2015] [Indexed: 12/17/2022] Open
Abstract
49,XXXXY pentasomy or Fraccaro's syndrome is the most severe variant of Klinefelter's syndrome (KS) affecting about 1/85000 male births. The classical presentation is the triad: mental retardation, hypergonadotropic hypogonadism and radio ulnar synostosis. Indeed, the reproductive function of Fraccaro's syndrome is distinguished from KS. Besides, Leydig cell tumors are described in cases of KS, but never documented in the Klinefelter variants.We describe a young adult of 22 years old who presented with hyper gonadotropic hypogonadism, delayed puberty and bilateral micro-cryptorchidism. Chromosomal pentasomy was confirmed since infancy. Bilateral orchidectomy revealed a unilateral well-circumscribed Leydig cell tumor associated with bilateral Leydig cell hyperplasia.Inspired from reporting the first case of Leydig cell tumor in a 49,XXXXY patient, we summarize the particularities of testicular function in 49,XXXXY from one side, and the risk and mechanisms of Leydig cell tumorigenesis in Klinefelter variants on the other side. The histological destructions in 49,XXXXY testes and hypogonadism are more profound than in Klinefelter patients, with early Sertoli, Leydig and germ cell destruction. Furthermore, the risk of Leydigioma development in KS and its variants remains a dilemma. We believe that the risk of Leydigioma is much higher in KS than the general population. By contrast, the risk could be lower in the Klinefelter variants with more than 3 supplementary X chromosomes, owing to an earlier and more profound destruction of Leydig cells rendering them irresponsive to chronic Luteinizing hormone (LH) stimulation.
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Affiliation(s)
- Salwan Maqdasy
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
- UMR CNRS 6293, INSERM U1103, Université Clermont-Auvergne, Génétique Reproduction et Développement, BP 10448, 63177, Aubiere, France.
- Service de Médecine Nucléaire, Centre Jean Perrin, 58 rue Montalembert, F-63011, Clermont-Ferrand, France.
| | - Laura Bogenmann
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
| | - Marie Batisse-Lignier
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
- UMR CNRS 6293, INSERM U1103, Université Clermont-Auvergne, Génétique Reproduction et Développement, BP 10448, 63177, Aubiere, France.
| | - Béatrice Roche
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
| | | | - Françoise Desbiez
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
| | - Igor Tauveron
- Service d'endocrinologie, diabétologie et maladies métaboliques, CHU Clermont-Ferrand, F-63003, Clermont-Ferrand, France.
- UMR CNRS 6293, INSERM U1103, Université Clermont-Auvergne, Génétique Reproduction et Développement, BP 10448, 63177, Aubiere, France.
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Hendry J, Fraser S, White J, Rajan P, Hendry DS. Retroperitoneal lymph node dissection (RPLND) for malignant phenotype Leydig cell tumours of the testis: a 10-year experience. SPRINGERPLUS 2015; 4:20. [PMID: 25625040 PMCID: PMC4300307 DOI: 10.1186/s40064-014-0781-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 12/30/2014] [Indexed: 11/12/2022]
Abstract
Retroperitoneal lymph node dissection (RPLND) is a prognostic, palliative, and potentially therapeutic procedure for patients with malignant phenotype Leydig cell tumours of the testis. We reviewed the records of patients diagnosed with malignant phenotype Leydig cell tumours of the testis treated by RPLND. Modified template dissection was performed in all cases with extra-template excision of tumour mass in Stage II disease. Routine clinico-radiological follow-up was performed. Six open RPLNDs (1 re-do procedure) were performed on 5 patients diagnosed with Stage I (n = 3) and Stage II (n = 2) malignant phenotype Leydig cell tumour of the testis. Median age = 63 years (range = 55-72). Median peri-operative blood loss = 1500 ml (range = 500-1500 ml). Median operating time = 6 h (range = 4.5-6.5). Two patients with Stage II disease developed post-operative complications of acute kidney injury (n = 1) and pneumonia (n = 1). Median length of stay was 8 days (range = 6-11). RPLND specimens from patients with Stage I were tumour-free, whilst patients with Stage II disease had evidence of metastatic tumour. At latest follow-up (median = 13 months, range = 7-22), no patient with Stage I disease had radiological evidence of recurrence, however the two patients with Stage II disease had died due to tumour recurrence at 13 months and 36 months. RPLND for malignant phenotype Leydig cell testicular tumours appears to be well tolerated. Despite surgery, overall outcomes for Stage II appear to be poor due to the disease phenotype. Larger prospective multi-centre studies are required to determine the definitive criteria for surgery in Stage I disease.
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Affiliation(s)
- Jane Hendry
- Department of Urology, Gartnavel General Hospital, G12 0YN 1053 Great Western Road, Glasgow, UK
| | - Sioban Fraser
- Department of Pathology, Southern General Hospital, G51 4TF 1345 Govan Rd, Glasgow, UK
| | - Jeff White
- Beatson West of Scotland Cancer Centre, G12 0YN 1053 Great Western Road, Glasgow, UK
| | - Prabhakar Rajan
- Department of Urology, Gartnavel General Hospital, G12 0YN 1053 Great Western Road, Glasgow, UK
| | - David S Hendry
- Department of Urology, Gartnavel General Hospital, G12 0YN 1053 Great Western Road, Glasgow, UK
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Gheorghisan-Galateanu AA. Leydig cell tumors of the testis: a case report. BMC Res Notes 2014; 7:656. [PMID: 25230718 PMCID: PMC4175283 DOI: 10.1186/1756-0500-7-656] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/16/2014] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Leydig cell tumors are the most common non-germ cell gonadal tumors with apparent increased incidence in the last few years. They are usually benign tumors. We report a case of Leydig cell tumor of testis in a patient presenting atypical features. CASE PRESENTATION A 29-year-old Caucasian man, born with right cryptorchidism, corrected without medical treatment before the age of two years, was diagnosed with Leydig cell tumor. Two years after diagnosis was identified moderately elevated estradiol serum level, in the context of a significant overweight, hormonal changes which had maintained after unilateral orchiectomy and after the patient's return to normal weight. Four years after unilateral orchiectomy, elevated value of estradiol persisted and subdiaphragmatic micro lymphadenopathy was observed. CONCLUSIONS Despite the favorable evolution of the patient four years after unilateral orchiectomy, long-term follow-up is necessary to exclude recurrence or metastasis to the testis. The endocrine profile and imaging investigations need to be repeated periodically. The changes in the hormonal assay and any new aspects on computed tomography scan can be used as a marker of tumor recurrence and require careful screening and the correct therapeutic decisions.
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Silberstein JL, Bazzi WM, Vertosick E, Carver BS, Bosl GJ, Feldman DR, Bajorin DF, Motzer RJ, Al-Ahmadie H, Reuter VE, Sheinfeld J. Clinical outcomes of local and metastatic testicular sex cord-stromal tumors. J Urol 2014; 192:415-9. [PMID: 24518791 DOI: 10.1016/j.juro.2014.01.104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE We evaluated pathological variables of testicular sex cord-stromal tumors, management options and clinical outcomes. MATERIALS AND METHODS We retrospectively reviewed the records of 48 patients with testicular sex cord-stromal tumors treated at Memorial Sloan-Kettering Cancer Center between 1997 and 2012. Clinical outcomes were compared based on treatment and previously described pathological factors associated with metastatic potential. RESULTS Of the 48 patients 37 underwent surveillance without retroperitoneal lymph node dissection, including 34 with no high risk feature and 3 with 1. Median followup was 14.5 months (IQR 6.9-32.5). No patient experienced recurrence. Retroperitoneal lymph node dissection was performed in 11 patients, including 6 with clinical stage I disease and 2 or more high risk features who underwent early dissection, 2 with clinical stage IIa disease at diagnosis who underwent early dissection and 3 with clinical stage I disease and 2 or more high risk features who were observed elsewhere but referred to our institution due to retroperitoneal disease. Six patients with clinical stage I disease underwent early dissection, 4 had no evidence of disease at a median followup of 6.6 years and 2 experienced recurrence and died of disease. Neither of the 2 patients with IIa disease at diagnosis experienced relapse. All 3 patients with delayed dissection experienced relapse and 1 died of disease. CONCLUSIONS Patients with testicular sex cord-stromal tumors and 1 or no high risk feature can be safely observed without retroperitoneal lymph node dissection but longer followup is needed. Given the lack of effective alternative treatments, early retroperitoneal lymph node dissection may be beneficial in those with 2 or more high risk features, or clinical stage IIa disease.
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Affiliation(s)
| | - Wassim M Bazzi
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Emily Vertosick
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Brett S Carver
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - George J Bosl
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Darren R Feldman
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Dean F Bajorin
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Robert J Motzer
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Victor E Reuter
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Joel Sheinfeld
- Urology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York
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Long-term follow up with sparing surgery for testicular diseases: A safe choice in benign testicular lesions. Rev Int Androl 2013. [DOI: 10.1016/j.androl.2013.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bremmer F, Schweyer S, Martin-Ortega M, Hammerlein B, Strauss A, Radzun HJ, Behnes CL. Switch of cadherin expression as a diagnostic tool for Leydig cell tumours. APMIS 2013; 121:976-81. [PMID: 23398382 DOI: 10.1111/apm.12053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 12/17/2012] [Indexed: 01/21/2023]
Abstract
Leydig cell tumours comprise about 3% of all testicular tumours. The pathogenesis of Leydig cell tumours is still poorly understood. We investigated testis with Leydig cell hyperplasia and Leydig cell tumours for their expression pattern of P- and N-cadherin. We could show a switch of expression of P- and N-cadherin in Leydig cell hyperplasia and Leydig cell tumours in comparison with normal Leydig cells. Cadherins could be established as a new immunohistochemical marker for this testicular tumour entity; their possible role in tumour genesis will be discussed.
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Leydig Cell Tumor Associated with Testicular Adrenal Rest Tumors in a Patient with Congenital Adrenal Hyperplasia due to 11β-Hydroxylase Deficiency. Case Rep Urol 2012; 2012:648643. [PMID: 22606635 PMCID: PMC3350130 DOI: 10.1155/2012/648643] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Accepted: 11/24/2011] [Indexed: 11/17/2022] Open
Abstract
Congenital adrenal hyperplasia (CAH) describes a group of inherited autosomal recessive disorders characterized by enzyme defects in the steroidogenic pathways that lead to the biosynthesis of cortisol, aldosterone, and androgens. Chronic excessive adrenocorticotropic hormone (ACTH) stimulation may result in hyperplasia of ACTH-sensitive tissues in adrenal glands and other sites such as the testes, causing testicular masses known as testicular adrenal rest tumors (TARTs). Leydig cell tumors (LCTs) are make up a very small number of all testicular tumors and can be difficult to distinguish from TARTs. This distinction is interesting because LCTs and TARTs require different therapeutic approaches. Hereby, we present an unusual case of a 19-year-old patient with CAH due to 11β-hydroxylase deficiency, who presented with TARTs and an epididymal Leydig cell tumor.
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Leonhartsberger N, Ramoner R, Aigner F, Stoehr B, Pichler R, Zangerl F, Fritzer A, Steiner H. Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques. BJU Int 2011; 108:1603-7. [DOI: 10.1111/j.1464-410x.2011.10177.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Heer R, Jackson MJ, El-Sherif A, Thomas DJ. Twenty-nine Leydig cell tumors: Histological features, outcomes and implications for management. Int J Urol 2010; 17:886-9. [DOI: 10.1111/j.1442-2042.2010.02616.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loeser A, Vergho DC, Katzenberger T, Brix D, Kocot A, Spahn M, Gerharz EW, Riedmiller H. Testis-sparing Surgery Versus Radical Orchiectomy in Patients With Leydig Cell Tumors. Urology 2009; 74:370-2. [DOI: 10.1016/j.urology.2009.03.014] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 03/03/2009] [Accepted: 03/06/2009] [Indexed: 11/26/2022]
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34
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Acar C, Gurocak S, Sozen S. Current Treatment of Testicular Sex Cord-stromal Tumors: Critical Review. Urology 2009; 73:1165-71. [DOI: 10.1016/j.urology.2008.10.036] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2008] [Revised: 09/19/2008] [Accepted: 10/17/2008] [Indexed: 11/25/2022]
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Management of non-germinal testicular tumors. World J Urol 2009; 27:507-12. [DOI: 10.1007/s00345-009-0403-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2009] [Accepted: 03/04/2009] [Indexed: 01/24/2023] Open
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Sex cord stromal testicular tumors: a clinical series--uniformly stage I disease. J Urol 2009; 181:2090-6; discussion 2096. [PMID: 19286222 DOI: 10.1016/j.juro.2009.01.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2008] [Indexed: 11/24/2022]
Abstract
PURPOSE Sex cord stromal testicular tumors are rare. Historically 10% of lesions are said to be malignant but to our knowledge there are no clinical or histological features that can accurately predict potential malignant behavior. Because of this, groups at some centers have advocated prophylactic retroperitoneal lymph node dissection in patients with clinical stage I disease. We reviewed our experience with these tumors to determine whether this policy is justified. MATERIALS AND METHODS We retrospectively reviewed the records of all 38 men older than 18 years with sex cord stromal testicular tumors who were referred to the Wessex regional cancer center for treatment or pathological review during the 25-year period of 1982 to 2006. We then compared our series with a malignant sex cord stromal testicular tumor database generated from the world literature. RESULTS All Wessex patients were treated with excision of the primary tumor alone and metastatic disease developed in none. All remained disease-free with an overall median survival of 6.8 years (range 1.4 to 25). Features in the literature favoring malignant behavior, ie metastatic disease, included larger tumors (mean 6.43 vs 1.71 cm), a high mitotic rate, tumor necrosis, angiolymphatic invasion, infiltrative margins and extratesticular extension (each p <0.0001). The malignant group had an overall median survival of 2.3 years (range 0.02 to 17.3). CONCLUSIONS No patient had disease progression in our study, which is to our knowledge the largest reported United Kingdom series of sex cord stromal testicular tumors. Our data suggest that malignancy is uncommon and prophylactic retroperitoneal lymph node dissection is unjustified for clinical stage I disease.
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Baki M, Takácsi Nagy L, Mayer A. [Chemo- and radiotherapy of germ cell testicular cancer in the literature]. Orv Hetil 2009; 150:203-7. [PMID: 19158018 DOI: 10.1556/oh.2009.28539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The study reviews the incidence, histologic types and prognostic factors of testicular cancer. The measurement of tumor-marker levels before castration determine the further activity regarding the data of imagings. The authors explain the treatment of seminoma and non-seminoma by stages. Carboplatin monotherapy is equivalent to the irradiation in early seminoma cases. Nowadays applied second and third line chemotherapies are reviewed. It is necessary to take into consideration not only the remission rate but also the late toxicity during the complex treatment of testicular germ cell cancer.
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Affiliation(s)
- Márta Baki
- Fovárosi Onkormányzat Uzsoki Utcai Kórháza Onkoradiológiai Központ Budapest Uzsoki u. 29. 1145
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Suardi N, Strada E, Colombo R, Freschi M, Salonia A, Lania C, Cestari A, Carmignani L, Guazzoni G, Rigatti P, Montorsi F. Leydig cell tumour of the testis: presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience. BJU Int 2009; 103:197-200. [DOI: 10.1111/j.1464-410x.2008.08016.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Huyghe E, Nohra J, Vezzozi D, Daudin M, Bennet A, Caron P, Thonneau P, Plante P. [Fertility before and after treatment of patients with Leydig cell tumour]. Prog Urol 2007; 17:841-5. [PMID: 17633998 DOI: 10.1016/s1166-7087(07)92304-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To determine the long-term fertility status of patients treated for Leydig cell testicular tumour. MATERIAL AND METHODS [corrected] In a series of 506 testicular tumours observed in the Midi-Pyrenées region between 1980 and 1998, 17 were Leydig cell tumours (3.3%) and constituted the study population. Andrological records were available for all patients. Information concerning fertility before and after orchidectomy was obtained by validated letter questionnaire. All patients completed the questionnaire. RESULTS The mean follow-up was 84 months (range: 36-173). The mean age at diagnosis was 32 years (range: 24-51). The presenting symptom was gynaecomastia in 9 cases (53%), enlarged testis in 4 cases (24%), scrotal pain in 2 cases (12%) and male infertility in 2 cases (12%). Before onset of their disease, 13/17 (76.5%) patients had tried to have a child and 6 (46.2%) had successfully fathered a child. After treatment of their Leydig cell tumour, 10/17 (58.8%) had tried to have a child and 7 (70%) were successful. CONCLUSION The population of men with Leydig cell tumour of the testis is a population with decreased fertility before treatment of the tumour. Resection of the tumour improves this situation, but 3 out of 10 patients remain infertile, indicating the need for semen storage measures in this population.
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Affiliation(s)
- Eric Huyghe
- Service d'Urologie et Andrologie, Hôpital Paule de Viguier Toulouse, France.
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Abstract
The great variety of non germinal testis tumours and their rarity explain the difficulties of a specific therapeutic management. The analysis of the most important varieties of tumours allows identifying an overall trend in both diagnosis and therapy.
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Carmignani L, Salvioni R, Gadda F, Colecchia M, Gazzano G, Torelli T, Rocco F, Colpi GM, Pizzocaro G. Long-Term Followup and Clinical Characteristics of Testicular Leydig Cell Tumor: Experience With 24 Cases. J Urol 2006; 176:2040-3; discussion 2043. [PMID: 17070249 DOI: 10.1016/j.juro.2006.07.005] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2005] [Indexed: 11/27/2022]
Abstract
PURPOSE The natural history of Leydig cell testicular tumors is not well known, and differentiation between malignant and benign forms is not easy. We performed a retrospective multicenter evaluation of clinical and histological characteristics as well as followup of Leydig cell tumors. MATERIALS AND METHODS From 1990 to August 2004 surgery was performed on 24 Leydig cell tumors. Before surgery all patients underwent clinical examination, tumor markers (alpha-fetoprotein, beta-human chorionic gonadotropin, lactate dehydrogenase), scrotal ultrasound and chest x-ray. Surgery was performed under ultrasound or palpation guidance via inguinotomy with clamping of the spermatic cord. Lesions less than 3 cm in diameter were resected and sent for frozen section examination. Histological criteria were considered. Abdominal computerized tomography or ultrasound and chest x-ray were performed postoperatively every 3 months for the first 2 years and every 6 months thereafter. RESULTS Patient age range was 22 to 61 years (mean 37.75). In 7 patients (29.2%) the lesion was palpable and incidental diagnosis was made in 10 patients (41.7%). In the other patients diagnosis was made by ultrasound performed for testicular pain (4 patients, 16.6%) or the appearance of gynecomastia (3 patients, 12.5%). Frozen section examination was done in 20 of 24 patients (83%). In 17 of 20 patients (85%) Leydig cell tumor was diagnosed on frozen section examination. All patients underwent radical orchiectomy. All definitive diagnoses interpreted the neoplasia as benign. Average followup was 117 months (range 11 to 241). There was no disease recurrence or progression and all patients are currently disease-free. CONCLUSIONS In our case study all Leydig cell tumors were interpreted as benign and long-term followup was negative.
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Affiliation(s)
- Luca Carmignani
- Urology Unit, Department of Medicine and Surgery, University of Milan, Italy.
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Conkey DS, Howard GCW, Grigor KM, McLaren DB, Kerr GR. Testicular Sex Cord–Stromal Tumours: The Edinburgh Experience 1988–2002, and a Review of the Literature. Clin Oncol (R Coll Radiol) 2005; 17:322-7. [PMID: 16097561 DOI: 10.1016/j.clon.2005.04.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Sex cord-stromal tumours of the testis are uncommon tumours, accounting for around 5% of testicular neoplasms. Treatment is primarily surgical, with no adjuvant therapy of proven benefit. We present a single-centre experience over a period of 15 years. MATERIALS AND METHODS From 1988 to 2002, 18 patients with a diagnosis of sex cord-stromal tumour were referred to our centre. A retrospective analysis of their case notes was made and a pathological review undertaken. RESULTS Sixteen were Leydig-cell tumours and two were Sertoli cell. For the Leydig-cell tumours, the median age at presentation was 42 years, 50% presented with a testicular mass and 31% with gynaecomastia. Two patients followed a malignant course: one revealing disease dissemination at initial staging, and a second 12 months after potentially curative orchidectomy. Salvage retroperitoneal lymphadenectomy in the latter patient proved unsuccessful. Clinical outcome correlated strongly with the presence of adverse pathological features described previously in the literature. After a median follow-up of 46 months, two patients have developed progressive disease, and two patients have died, one of metastatic Leydig-cell tumour. No patient defined as being of low malignant potential on pathological examination has relapsed outside our review period of 2 years. CONCLUSION We confirm the overall excellent prognosis for most of the patients with sex cord-stromal tumours of the testis. Compared with most previous reports, pathological features seem to predict with reasonable accuracy the risk of malignant behaviour, and can adequately inform the subsequent review policy.
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Affiliation(s)
- D S Conkey
- Urological Oncology Section, Edinburgh Cancer Centre, Western General Hospital, Edinburgh, UK
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Peschel R, Gettman MT, Steiner H, Neururer R, Bartsch G. Management of Adult Leydig-Cell Testicular Tumors: Assessing the Role of Laparoscopic Retroperitoneal Lymph Node Dissection. J Endourol 2003; 17:777-80. [PMID: 14642042 DOI: 10.1089/089277903770802362] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND PURPOSE Leydig-cell tumors represent <5% of malignant testicular tumors in adults. Orchiectomy is curative in approximately 90% of cases; however, the remaining men can develop metastases refractory to chemotherapy and radiation. We evaluated the role of laparoscopic retroperitoneal lymph node dissection (RPLND) in adult Leydig-cell tumors. PATIENTS AND METHODS Between 1999 and 2001, laparoscopic RPLND was performed with four transperitoneal ports within a unilateral template for six patients with pure Leydig-cell tumors. Presenting signs and symptoms, operative time, blood loss, intraoperative complications, postoperative complications, length of hospitalization, pathology reports, ejaculatory function, and survival were reviewed retrospectively. RESULTS Laparoscopic RPLND was successful, without open conversions or reinterventions. Two vascular injuries occurred during dissection; additional intraoperative complications were not observed. Postoperatively, one patient developed erysipelas, but no other postoperative complications were recorded. The mean operative time was 190 minutes, and the mean length of hospitalization was 4.3 days. Pathologic analysis of lymph nodes revealed no evidence of metastatic Leydig-cell tumor. At 12 months' mean follow-up (range 3-29 months), no recurrences have been identified. CONCLUSIONS Laparoscopic RPLND is a safe, minimally invasive procedure for Leydig-cell tumors. Additional clinical experience is required to evaluate its effectiveness for pathologic stage II tumors and to determine if a therapeutic advantage can be realized with a protocol employing laparoscopic RPLND for adult Leydig-cell tumors.
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Mosharafa AA, Foster RS, Bihrle R, Koch MO, Ulbright TM, Einhorn LH, Donohue JP. Does retroperitoneal lymph node dissection have a curative role for patients with sex cord-stromal testicular tumors? Cancer 2003; 98:753-7. [PMID: 12910519 DOI: 10.1002/cncr.11573] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Sex cord-stromal tumors account for < 5% of all adult testicular tumors, and 10% are malignant. Due to the limited reported experience, there is no agreement on the best management, especially in patients who have tumors with malignant pathologic features or who present with metastatic disease. The authors attempt to evaluate the role of retroperitoneal lymph node dissection (RPLND) in the management of patients with these malignant sex cord-stromal tumors. METHODS Reviewing the Indiana University testis cancer registry revealed 17 patients who underwent RPLND for sex cord-stromal tumors. Pathology was reviewed for features suggestive of malignancy. The data examined included clinical and pathologic stage, surgical procedure, additional therapy received, and outcome. RESULTS Pathology included Leydig tumors in six patients, Sertoli tumors in four patients, sex cord-stromal tumors in five patients, a granulosa cell tumor in one patient, and a poorly differentiated non-germ cell tumor in one patient. Nine patients had histologic features suggestive of malignancy. Clinical stage at surgery was Stage I in nine patients and Stage IIA-IIIA in eight patients. Patients underwent modified or bilateral RPLND. Nine patients had pathologic Stage I tumors, and the remaining eight patients and had pathologic Stage IIB-IIIA tumors. Follow-up ranged from 8 months to 11 years. Of the eight patients with Stage II-III disease, six patients eventually died of metastatic disease despite additional radiotherapy and/or chemotherapy. CONCLUSIONS Sex cord-stromal tumors have a potentially aggressive malignant behavior that is difficult to predict based on clinical and pathologic features. Although the therapeutic role of RPLND in patients with small-volume metastatic retroperitoneal tumors is unclear, RPLND remains an option to be performed immediately after orchiectomy, especially in patients who have tumors with malignant features and/or small-volume metastatic disease.
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Affiliation(s)
- Ashraf A Mosharafa
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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