Leydig cell tumor: a case report with reference to its endocrinological features

Leydig cell tumors of the testis: a case report

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.

Hemorrhagic shock caused by rupture of an intra-abdominal leydig cell tumour: case report

The rupture of an intra-abdominal testicular neoplasm is a rare cause of acute abdomen and massive intra-abdominal haemorrhage. We report the case of a 70-year-old male presenting a massive intra-abdominal bleeding caused by a Leydig cell tumour in an undescended testis. The clinical details and pathology of this rare testicular tumour are discussed.

A malignant Leydig cell tumor of the testis

A 40-year-old man was referred to our hospital with gynecomastia and painless swelling of the right scrotum. Ultrasonography revealed a 15 x 10 mm mass with low echogenicity of the right testis. We performed right high orchiectomy. Histologically, Reinke's crystals and capsular invasion by tumor cells were found. Final diagnosis, the tumor was a malignant Leydig cell tumor of the testis.

Elevated serum estradiol suggesting recurrence of Leydig cell tumor nine years after radical orchiectomy

We report a case of a Leydig cell tumor that showed retroperitoneal lymph node metastasis 9 years after radical orchiectomy. Elevated serum estradiol (E2) suggested recurrence of the Leydig cell tumor. Retroperitoneal lymph node dissection (RPLND) was performed and the lymph node was proved histopathologically to have a metastatic Leydig cell tumor. After RPLND, serum E2 returned to the normal range. This is the first reported case in which changes in the endocrinological findings were useful as likely tumor markers to detect the recurrence of a Leydig cell tumor.

Role of retroperitoneal lymph node dissection in clinical stage I Leydig cell tumours

Leydig Cell Tumours (LCT) account for 3% of all testicular tumours; 10% are malignant and are refractory to radio- and chemotherapy. The role of Retroperitoneal Lymph Node Dissection in clinical stage I LCT is therefore a particularly debated one. From March ‘83 to December ‘95, 10 patients with LCT were subjected to orchiectomy (1 of them bilaterally because of a metachronous tumour). In 10 out of 11 specimens the following pathological features – a) size larger than 50 mm, b) infiltration of spermatic cord, c) lymphatics and veins, d) capsule, e) necrosis, f) cellular pleomorphism, g) numerous mitoses, h) nuclear atypia – were absent. The only patient in which b) and d) were present was subjected to RPLND. After a follow-up ranging from 17 to 157 months all patients are disease-free. Abstention from RPLND in clinical stage I LCT therefore seems the more rational choice when the above- listed pathologic features are absent.