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Yang X, Quan LJ. Ultrasound contrast-enhanced diagnosis of testicular Leydig cell tumor: A case report and literature review. J Clin Ultrasound 2024. [PMID: 38450802 DOI: 10.1002/jcu.23665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Eyer de Jesus L, Paz de Oliveira AP, Porto LC, Dekermacher S. Testicular adrenal rest tumors - Epidemiology, diagnosis and treatment. J Pediatr Urol 2024; 20:77-87. [PMID: 37845103 DOI: 10.1016/j.jpurol.2023.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/08/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
INTRODUCTION Testicular adrenal rest tumors (TART) are common in males suffering from congenital adrenal hyperplasia (CAH). Correct and timely diagnosis is important for differential diagnosis with malignant testis tumors, related infertility and as TART may worsen in time, especially in the absence of adequate and continuous hormonal control. The rarity of the disease, predominance of small cohorts and case reports and research heterogeneity (concerning type of CAH, patients' age and specific focus of the paper) complicate the understanding of this condition. OBJECTIVES To review epidemiological and clinical aspects of TART, including treatment and prognosis. METHODS Non-systematic review of CAH-related TART research. RESULTS TART's prevalence grows progressively over time, predominating after puberty, affecting a mean of 20-40 % of CAH males. There is no proof of more frequent proportional affection of specific CAH phenotypes or types of enzyme deficiency, but cases of TART among non-classic CAH patients have been rarely reported. Chronic undertreated are more frequently affected and present larger tumors. Systematic ultrasound screening of CAH males is the state-of-the art for diagnosis, but TART are still often diagnosed in CAH adults seeking infertility treatment. TART are usually asymptomatic and present normal testicular volume. Biopsies are not recommended, except when the differential diagnosis between TART and testicular tumors cannot be guaranteed. Abnormal semen analysis is common. Leydig cell tumors are the main differential diagnosis, due to histological similarities to TART. Misdiagnosis may lead to unnecessary orchiectomies. Preservation of gonadal functions is inversely proportional to the total tumor volume. Tumors tend to regress under adequate adrenal suppression with steroids. Surgery in not indicated to treat TART. DISCUSSION The reported prevalence of TART depends on age, usage of systematic follow-up ultrasound, and adequate CAH control. Timely detection of the disease is important to avoid irreversible gonadal dysfunction (not clinically apparent, due to high serum levels of androgen) and infertility. The relationship between TART and specific CAH phenotypes/genotypes has not been proved, and some cases do not present abnormal serum ACTH levels. Knowledge about TART should be disseminated among non-experts, to avoid unnecessary orchiectomies and false diagnosis of malignant testis tumors. Infertility is frequent, but has not been not satisfactorily addressed by physicians, even among experts. Sperm cryopreservation should be early offered to CAH adult males, but there are offer problems related to high cost.
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Affiliation(s)
- Lisieux Eyer de Jesus
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil.
| | - Ana Paula Paz de Oliveira
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Luiza Coutinho Porto
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil
| | - Samuel Dekermacher
- Department of Pediatric Surgery and Urology, Servidores Do Estado Hospital, Ministry of Health, Rio de Janeiro, Brazil
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Baweja K, Shuster S, Awad S. The Use of Ovarian Vein Sampling to Lateralize a Virilizing Leydig Cell Ovarian Tumor. AACE Clin Case Rep 2023; 9:182-185. [PMID: 38045790 PMCID: PMC10690409 DOI: 10.1016/j.aace.2023.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background/Objective Leydig cell tumors are a rare androgen-secreting ovarian tumor. We present a patient with virilization symptoms secondary to a Leydig cell tumor, with nonrevealing imaging studies, that was localized using ovarian vein sampling (OVS). Case Report A 56-year-old postmenopausal woman was referred by her gynecologist to the endocrinology clinic for voice-deepening, clitoral enlargement, scalp hair loss, and excessive body hair growth. Her total testosterone was 11.5 (0.3-1.3 nmol/L), bioavailable testosterone was 7.19 (0.1-0.6 nmol/L), and dehydroepiandrosterone sulfate was 4.0 (0.8-4.9 μmol/L). Transvaginal ultrasound and abdominal magnetic resonance imaging showed no adrenal or ovarian masses bilaterally. On adrenal vein sampling (AVS) and OVS, total testosterone from the left gonadal vein was 780.0 (0.3-1.3 nmol/L) and right gonadal vein was 18.6 (0.3-1.3 nmol/L), with a left-to-right ovarian testosterone ratio of 41.94. A bilateral salpingo-oophorectomy was performed, and a 1.0 cm Leydig cell tumor in the left ovary was noted on histopathology. One month after surgery, her total and bioavailable testosterone were <0.4 (0.3-1.3 nmol/L and 0.1-0.6 nmol/L, respectively). At 6 months, she had normalization of her voice to baseline, decreased clitoral size, decreased hair growth on her back, and improvement in her male-pattern baldness. Discussion OVS and AVS are useful diagnostic investigation tools in cases of virilization, in which imaging is nonrevealing. Our case supports previously suggested left-to-right ovarian vein testosterone ratio of ≥15 being associated with a left-sided tumor. Conclusion Few cases have been published on the interpretation of AVS and OVS in the setting of virilization. Previously suggested ratios for lateralization were valid for this patient.
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Affiliation(s)
- Kirun Baweja
- Department of Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Shirley Shuster
- Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada
| | - Sara Awad
- Division of Endocrinology and Metabolism, Queen’s University, Kingston, Ontario, Canada
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Ojewola RW, Aranmolate RA. Leydig Cell Testicular Tumor Presenting as Bilateral Breast Masses: A Case Report. J West Afr Coll Surg 2023; 13:119-122. [PMID: 38449551 PMCID: PMC10914104 DOI: 10.4103/jwas.jwas_54_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/07/2023] [Indexed: 03/08/2024]
Abstract
Leydig cell tumors are rare but are the most common nongerm cell gonadal tumors. They are mostly benign but malignant variants have been reported. Leydig cells constitute the main androgen-synthesizing compartment in adult males but are also capable of estrogen production. This can manifest with clinical features of excessive hormone elaboration. We report a case of a 39-year-old man with abnormal bilateral breast development, reduced libido, and weak erection of 3 years' duration. He never noticed any testicular swelling before presentation. Examination revealed well-developed breasts bilaterally and a mass in the lower pole of the left testis. Scrotal ultrasound confirmed a hypoechoic tumor measuring 2 × 3 cm in the lower pole of the left testis and hormonal evaluation revealed a markedly elevated estradiol level. A diagnosis of estrogen-secreting testicular tumor was made. He had a testis-sparing excision of the scrotal lesion as well as liposuction and excision of glandular tissues of the breasts. He had an uneventful postoperative recovery and was discharged a day after surgery. Histology of excised testicular lesion revealed a benign Leydig cell tumor. Four months following surgery, there was an improvement in libido, erection, and sperm concentration of the patient. The patient was also very satisfied with the cosmetic outcome of the excision of the bilateral gynecomastia. We recommend self-examination of testicles as an important step for early diagnosis of testicular tumors.
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Affiliation(s)
- Rufus Wale Ojewola
- Department of Surgery, Faculty of Clinical Sciences, College of Medicine of University of Lagos/Lagos University Teaching Hospital, Idi-araba, Surulere, Lagos, Nigeria
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Yamamoto Y, Taiji R, Takewa M, Kitatsuji W, Okura A, Saito N, Ohyama N, Tachiiri T, Nishiofuku H, Itoh T, Marugami N, Tanaka T. Leydig cell tumor of the testis with characteristic contrast patterns of tumor and non-tumorous testicular parenchyma on MRI: a case report. Abdom Radiol (NY) 2023; 48:2477-2482. [PMID: 37165207 DOI: 10.1007/s00261-023-03932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Testicular Leydig cell tumor (LCT) is a rare subtype of testicular neoplasms that occurs in the interstitial tissue of testes, accounting for 1-3% of total testicular masses removed annually. We report a case of 70-year-old man diagnosed as testicular LCT. This report demonstrates a testicular LCT with intratumoral and non-tumorous testicular parenchymal enhancement in the affected testis, which should be considered characteristic findings of LCT. METHODS Ultrasonography showed a hypoechoic mass. On magnetic resonance imaging, the tumor showed low signal intensity comparable to the surrounding testicular tissue on T1-weighted images (T1WI) and low signal intensity on T2-weighted images (T2WI). On gadolinium contrast-enhanced T1WI (CE-T1WI), the tumor showed a rapid and marked wash-in and subsequent prolonged washout. The spared, non-tumorous testicular parenchyma showed slow and progressive enhancement in the early phase, which was as strong as or stronger than that of the mass in the delayed phase. The patient underwent right orchiectomy. RESULTS Pathologically, the tumor was diagnosed as a testicular Leydig cell tumor (LCT). Leydig cell proliferation was observed with well-developed microvessels, atrophy of the seminiferous tubules, and stromal edema in the non-tumorous testicular parenchyma. Leydig cells in the non-tumorous parenchyma were positive for estrogen receptors. CONCLUSION Since the contrast findings in the non-tumorous testicular parenchymal region on CE-T1WI likely match the histopathological features of LCT, our case suggests that the presence of non-tumorous testicular parenchymal enhancement on imaging might indicate a diagnosis of LCT.
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Affiliation(s)
- Yuji Yamamoto
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Ryosuke Taiji
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan.
| | - Megumi Takewa
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Wataru Kitatsuji
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Akira Okura
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Naotoshi Saito
- Department of Pathology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Nobuo Ohyama
- Department of Urology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Tetsuya Tachiiri
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Hideyuki Nishiofuku
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Takahiro Itoh
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Nagaaki Marugami
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
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Gullu M, Aydın S, Kalkan T, Pınarcı T, Turkkahraman D. A Boy with 46,XX Karyotype (SRY double-positive) having a Leydig Cell Tumor. J Clin Res Pediatr Endocrinol 2023. [PMID: 36987810 DOI: 10.4274/jcrpe.galenos.2023.2022-9-14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
Leydig cell tumors are the most common type of testicular sex cord stromal tumors. Presence of Y chromosome is associated with tumor risk in sex development disorder (DSD), however tumor development without Y chromosome are extremely rare. A 16-year-old boy diagnosed with Leydig cell tumor due to a mass in the right testis was referred after the right orchiectomy. In physical examination, left testis was 10 ml, and a labium residue in penoscrotal region with bilateral gynecomastia was present. Karyotype was 46,XX, and SRY was double-positive in FISH analysis. Ifosfamide, carboplatin and etoposide chemotherapy was initiated due to Leydig cell tumor. Here, we report the first pediatric case having 46,XX, SRY double-positive testicular DSD with Leydig cell tumor.
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Affiliation(s)
- Merve Gullu
- Department of Pediatric Endocrinology, University of Health Science, Antalya Training and Research Hospital, Antalya, Turkey
| | - Sultan Aydın
- Department of Pediatric Hematology and Oncology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Tarkan Kalkan
- Bio-Gen Genetic Diseases Evaluation Center, Antalya, Turkey
| | - Tangül Pınarcı
- Department of Pathology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Doğa Turkkahraman
- Department of Pediatric Endocrinology, University of Health Science, Antalya Training and Research Hospital, Antalya, Turkey
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Lee YP, Lin CR, Chen SS, Chen RJ, Wu YH, Chen YH, Huang BM. Combination treatment of cordycepin and radiation induces MA-10 mouse Leydig tumor cell death via ROS accumulation and DNA damage. Am J Cancer Res 2023; 13:1329-1346. [PMID: 37168338 PMCID: PMC10164788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 03/19/2023] [Indexed: 05/13/2023] Open
Abstract
Leydig cell tumor is the most frequent non-germ cell tumors of testis. The biggest challenge of using radiotherapy to treat testicular cancer is in effectively killing cancer cells and maintaining reproductive function after treatment. Our recently published article showed that cordycepin could enhance radiosensitivity to induce mouse Leydig tumor cell apoptosis by inducing cell cycle arrest, caspase pathway and endoplasmic reticulum (ER) stress. In the present study, the potency and mechanism of a previous combination treatment protocol on reactive oxygen species (ROS) induction and DNA damage were further investigated. Our results reveal that 25 μM cordycepin plus 4 Gy radiation leads to ROS accumulation accompanied by a decrease in heme oxygenase (HO)-1 protein expression in MA-10 mouse Leydig tumor cells. Subsequently, pronounced DNA damage with phosphorylated H2A histone family member X (γ-H2AX) increase and activation of DNA damage-related signaling pathways including double and single stranded break-induced ataxia telangiectasia mutated (ATM)/checkpoint kinase (Chk)2 and ataxia telangiectasia mutated and Rad3 related (ATR)/Chk1 signaling axes were identified. p53-dependent pathway was then initiated ultimately leading to cell death. Preincubated with free radical scavenger, N-acetylcysteine (NAC), down-regulated γ-H2AX expression in treated cells and partially reduced cell death, indicating that ROS overproduction is involved in combination treatment-induced DNA damage. Furthermore, the combination treatment effectively inhibited tumor growth as reflected in the reduction of tumor volume, size and weight, and high expression level of γ-H2AX in tumor tissue in vivo, suggesting that the combination treatment inhibited tumor growth via causing DNA damage in MA-10 cells. In summary, these results expound that the combination treatment of cordycepin and radiation induces MA-10 mouse Leydig tumor cell death through ROS accumulation and DNA damage. This finding can serve as a reference guideline for future clinical therapy of testicular cancer and provide potential targets for anti-cancer drug design.
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Affiliation(s)
- Yi-Ping Lee
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan, ROC
| | - Chin-Ru Lin
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan, ROC
| | - Sih-Shang Chen
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan, ROC
| | - Rong-Jane Chen
- Department of Food Safety/Hygiene and Risk Management, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan, ROC
| | - Yuan-Hua Wu
- Department of Radiation Oncology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan, ROC
| | - Ying-Hui Chen
- Department of Anesthesia, Chi-Mei Medical CenterLiouying, Tainan 73657, Taiwan, ROC
| | - Bu-Miin Huang
- Department of Cell Biology and Anatomy, College of Medicine, National Cheng Kung UniversityTainan 70101, Taiwan, ROC
- Department of Medical Research, China Medical University Hospital, China Medical UniversityTaichung 40402, Taiwan, ROC
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Bapir R, Salih RQ, Salih KM, Shabur B, Salih AM, Kakamad FH, Abdullah HO, Fattah FH, Mohammed SH. Simultaneous Sertoli Cell-Only Syndrome and Leydig Cell Tumor in a Patient with Azoospermia: A Rare Case Report. Case Rep Oncol 2022; 15:1095-1100. [PMID: 36605229 PMCID: PMC9808302 DOI: 10.1159/000526668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/04/2022] [Indexed: 12/14/2022] Open
Abstract
Testicular cancers comprise 1-1.5% of entire cancers in men, and sex cord-stromal tumors include 5% of testicular cancers. This study aims to report a simultaneous Sertoli cell-only syndrome and Leydig cell tumor in the same patient. A 32-year-old man presented with a history of primary infertility for 3 years. Physical examination revealed normal secondary sexual characteristics. Two successive seminal fluid analyses revealed azoospermia. A scrotal ultrasound scan showed a 28 × 27 mm hypoechoic and hypervascular right testicular mass. Right radical orchiectomy and simultaneous left testicular biopsy were conducted. The histopathological examination revealed Sertoli cell-only syndrome and Leydig cell tumor with focal Leydig cell hyperplasia. Reversing fertility following the management of Leydig cell tumor is rarely mentioned in the literature. A study revealed that fertility recovered following 4 months of management in a primary infertile male. However, infertile men with nonobstructive azoospermia due to SCOS can only have a child by testicular sperm extraction technique. Despite the rare occurrence of Leydig cell tumor, it could be seen in association with Sertoli cell-only syndrome in infertile men with azoospermia. Clinical examination and imaging studies are important in these patients as the possibility of having a testicular mass is high among them.
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Affiliation(s)
- Rawa Bapir
- Smart Health Tower, Sulaimani, Iraq,Department of Urology, Surgical Teaching Hospital, Sulaimani, Iraq,Kscien Organization, Sulaimani, Iraq
| | - Rawezh Q. Salih
- Smart Health Tower, Sulaimani, Iraq,Kscien Organization, Sulaimani, Iraq
| | - Karzan M. Salih
- Smart Health Tower, Sulaimani, Iraq,Iraqi Board for Medical Specialities, Sulaimani Center, Sulaymaniyah, Iraq
| | | | - Abdulwahid M. Salih
- Smart Health Tower, Sulaimani, Iraq,College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Fahmi H. Kakamad
- Smart Health Tower, Sulaimani, Iraq,Kscien Organization, Sulaimani, Iraq,College of Medicine, University of Sulaimani, Sulaimani, Iraq
| | - Hiwa O. Abdullah
- Smart Health Tower, Sulaimani, Iraq,Kscien Organization, Sulaimani, Iraq
| | - Fattah H. Fattah
- Smart Health Tower, Sulaimani, Iraq,College of Medicine, University of Sulaimani, Sulaimani, Iraq
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Abiuso AMB, Varela ML, Raices T, Irusta G, Lazzati JM, Besio Moreno M, Cavallotti A, Belgorosky A, Pignataro OP, Berensztein E, Mondillo C. Histidine decarboxylase inhibitors: a novel therapeutic option for the treatment of leydigioma. J Endocrinol 2022; 255:103-116. [PMID: 36069766 DOI: 10.1530/joe-21-0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 09/07/2022] [Indexed: 11/08/2022]
Abstract
Recent reports indicate an increase in Leydig cell tumor (LCT) incidence. Radical orchiectomy is the standard therapy in children and adults, although it entails physical and psychosocial side effects. Testis-sparing surgery can be a consideration for benign LCT of 2.5 cm or less in size. Malignant LCTs respond poorly to conventional chemotherapy, so new treatment modalities are needed. In this study, we observed increased histidine decarboxylase expression and pro-angiogenic potential in LCT surgically resected from pediatric patients (fetal to pubertal) vs control samples from patients without endocrine or metabolic disorders which were collected at necropsy. We, therefore, evaluated for the first time the antitumor efficacy of two histidine decarboxylase inhibitors (α-methyl-dl-histidine dihydrochloride (α-MHD) and epigallocatechin gallate (EGCG)), alone and combined with carboplatin, in two preclinical models of LCT. MA-10 and R2C Leydig tumor cells, representing two different LCT subtypes, were used to generate syngeneic and xenograft mouse LCT models, respectively. In the syngeneic model, monotherapy with α-MHD effectively reduced tumor growth and angiogenesis. In the xenografts, which showed co-expression of histidine decarboxylase and CYP19, the combination of EGCG plus carboplatin was the most effective therapy, leading to LCT growth arrest and undetectable levels of plasmatic estradiol. Testicular and body weights remained unaltered. On the basis of this study, histidine decarboxylase may emerge as a novel pharmacological target for LCT treatment.
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Affiliation(s)
- Adriana María Belén Abiuso
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - María Luisa Varela
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Trinidad Raices
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Griselda Irusta
- Laboratory of Ovarian Physiology and Tumor Biology, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Juan Manuel Lazzati
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Marcos Besio Moreno
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Alina Cavallotti
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
| | - Alicia Belgorosky
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Omar Pedro Pignataro
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
- Department of Biological Chemistry, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Esperanza Berensztein
- Endocrinology Service, Hospital de Pediatría 'Prof. Dr. Juan P. Garrahan', Buenos Aires, Argentina
| | - Carolina Mondillo
- Laboratory of Molecular Endocrinology and Signal Transduction, Instituto de Biología y Medicina Experimental (IBYME-CONICET), Buenos Aires, Argentina
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Samar MR, Khan SR, Tariq M, Soomar SM, Shahzadi M. Bilateral congenital cryptorchidism and unilateral Leydig cell tumor in an adult presenting with gynecomastia and primary infertility: A case report. Int J Surg Case Rep 2022; 93:106923. [PMID: 35303605 PMCID: PMC8927705 DOI: 10.1016/j.ijscr.2022.106923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/10/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance The neoplasms of the testis are sporadic tumors among men. Furthermore, the rarest subset of these is neoplasms belonging to the stromal tumors of the sex cord. Leydig cell tumors are the most common form among the testicular stromal tumors. In our case, the underlying risk factor associated with the development of Leydig cell tumors was cryptorchidism. While mostly unilateral, cases of bilateral cryptorchidism may be present and have been rarely reported. Case presentation We report a 36-year-old gentleman who presented to us with the inability to carry off intercourse without difficulty attaining erection on stimulation for the past two years. He had a history of left undescended testis since birth, for which he underwent left orchidopexy 20 years ago. An ultrasound of the pelvis showed an oval hypoechoic-shaped heterogeneous mass in the right mid-inguinal canal. Relevant blood investigations showed a deranged hormonal profile. He then underwent an uneventful right radical orchiectomy, histopathology of which was consistent with Leydig cell tumor. Clinical discussion LCT with a history of bilateral cryptorchidism has rarely been reported. This case highlights its clinical presentation, management, and further follow-up in such patients. Conclusion Bilateral congenital cryptorchidism may be associated with Leydig cell tumor years later in life hence long-term follow-up is required for these patients. The clinical presentation of these tumors may vary among individuals. Any change in physical appearance, hormonal assay, and imaging studies should promptly be followed for possible surgical resection and close monitoring. Bilateral congenital cryptorchidism may be associated with LCT, years later in life. The clinical presentation of these tumors may vary among individuals. Such patients need periodic monitoring of hormonal profiles and imaging studies.
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Affiliation(s)
| | - Saqib Raza Khan
- Department of Oncology, Aga Khan University, Karachi, Pakistan.
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11
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Hoggard NK, Craig LE. Medullary bone in male budgerigars ( Melopsittacus undulatus) with testicular neoplasms. Vet Pathol 2022; 59:333-339. [PMID: 35001765 DOI: 10.1177/03009858211069126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Medullary bone is a calcium-rich, labile bone normally occurring in female birds with each egg-laying cycle. The stimulus for formation of medullary bone is, in part, the cyclic increase in serum estrogens produced by preovulatory ovarian follicles. Increased bone density due to formation of medullary bone, particularly in pneumatic bones, has been termed polyostotic hyperostosis, even if physiologic. This study investigated the formation of medullary bone in nonpneumatic (femur) and pneumatic (humerus) bones in sexually mature male budgerigars submitted for autopsy. Of the 21 sexually mature male budgerigars submitted for autopsy, 7 (33%) had medullary bone in 1 or more bones examined. All 7 male budgerigars with medullary bone had a testicular neoplasm, which was morphologically consistent with a testicular sustentacular cell tumor, seminoma, or interstitial cell tumor. Medullary bone was not present in the 14 cases with other diseases. Medullary bone formation in pneumatic and nonpneumatic bones can occur in male budgerigars with testicular neoplasms. Radiographic increases in medullary bone density, particularly in the humerus, could provide antemortem indication of testicular neoplasia in male budgerigars.
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Campolo F, Capponi C, Tarsitano MG, Tenuta M, Pozza C, Gianfrilli D, Magliocca F, Venneri MA, Vicini E, Lenzi A, Isidori AM, Barbagallo F. cAMP-specific phosphodiesterase 8A and 8B isoforms are differentially expressed in human testis and Leydig cell tumor. Front Endocrinol (Lausanne) 2022; 13:1010924. [PMID: 36277728 PMCID: PMC9585345 DOI: 10.3389/fendo.2022.1010924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 09/06/2022] [Indexed: 11/21/2022] Open
Abstract
Cyclic adenosine monophosphate/Protein kinase A (cAMP/PKA) signaling pathway is the master regulator of endocrine tissue function. The level, compartmentalization and amplitude of cAMP response are finely regulated by phosphodiesterases (PDEs). PDE8 is responsible of cAMP hydrolysis and its expression has been characterized in all steroidogenic cell types in rodents including adrenal and Leydig cells in rodents however scarce data are currently available in humans. Here we demonstrate that human Leydig cells express both PDE8A and PDE8B isoforms. Interestingly, we found that the expression of PDE8B but not of PDE8A is increased in transformed Leydig cells (Leydig cell tumors-LCTs) compared to non-tumoral cells. Immunofluorescence analyses further reveals that PDE8A is also highly expressed in specific spermatogenic stages. While the protein is not detected in spermatogonia it accumulates nearby the forming acrosome, in the trans-Golgi apparatus of spermatocytes and spermatids and it follows the fate of this organelle in the later stages translocating to the caudal part of the cell. Taken together our findings suggest that 1) a specific pool(s) of cAMP is/are regulated by PDE8A during spermiogenesis pointing out a possible new role of this PDE8 isoform in key events governing the differentiation and maturation of human sperm and 2) PDE8B can be involved in Leydig cell transformation.
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Affiliation(s)
- Federica Campolo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Chiara Capponi
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Maria Grazia Tarsitano
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Marta Tenuta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Carlotta Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Magliocca
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Mary A. Venneri
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Elena Vicini
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Andrea M. Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - Federica Barbagallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
- Faculty of Medicine and Surgery, Kore University of Enna, Enna, Italy
- *Correspondence: Federica Barbagallo,
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13
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Akbarzadeh Pasha A, Shafi H, Teimorian M, Rostami G, Nasirimehr K, Moudi E. Congenital adrenal hyperplasia presented with bilateral testicular tumor: A case report. Caspian J Intern Med 2021; 12:S431-S434. [PMID: 34760099 PMCID: PMC8559653 DOI: 10.22088/cjim.12.0.431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/08/2022]
Abstract
Background: Congenital adrenal hyperplasia (CAH) refers to group of congenital diseases resulting from impaired adrenal steroidogenesis, and its most common cause is 21-hydroxylase deficiency. Testicular adrenal residual tumor (TART) is one of the major complications of CAH, possibly resulting from ectopic remnants of intra-testicular adrenal tissue which is stimulated by excessive secretion of adrenocorticotropic hormone (ACTH). This tumor can be misdiagnosed as Leydig cell tumor (LCT) in these people. Case Presentation: The patient we are presenting is a 20-year-old man with a history of precocious puberty and a height below 3% of the population who underwent radical left testicular orchiectomy with a complaint of bilateral testicular mass, which is reported LCT in the pathology report. In preoperative imaging examinations, bilateral adrenal hyperplasia is observed. In hormonal examinations, the patient is diagnosed with CAH and has been treated with corticosteroids for one year. Conclusion: In patients who present with bilateral testicular mass, it is the best image by abdominopelvic CT scan before surgery to detect CAH.
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Affiliation(s)
- Abazar Akbarzadeh Pasha
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Hamid Shafi
- Clinical Research Development Center, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, I.R.Iran
| | - Mohamad Teimorian
- Department of Urology, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
| | - Ghasem Rostami
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Khatereh Nasirimehr
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Emadoddin Moudi
- Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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14
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Ory J, Blankstein U, Gonzalez DC, Sathe AA, White JT, Delgado C, Reynolds J, Jarvi K, Ramasamy R. Outcomes of organ-sparing surgery for adult testicular tumors: A systematic review of the literature. BJUI Compass 2021; 2:306-321. [PMID: 34568872 PMCID: PMC8462801 DOI: 10.1002/bco2.77] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective To perform a systematic review on the effects of testicular sparing surgery (TSS) on the oncological, functional, and hormonal outcomes of adults with testicular tumors. Methods A literature search was performed after PROSPERO registration (CRD42020200842) and reported in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methods. We conducted a systematic search of Medline (Ovid), Embase, Cochrane CENTRAL, CINAHL, Scopus, Web of Science, ClinicalTrials.gov, and the WHO/ICTRP from inception to November 20, 2020. Manuscripts and published abstracts were included if they involved testis-sparing surgery (TSS) and contained data on any outcomes related to fertility, hormonal parameters, or oncological control, or if they evaluated surgical technique. Results Our initial search yielded 3,370 manuscripts, with 269 of these screened for full-text eligibility. After our exclusion criteria were applied, 32 studies were included in the final analysis. Oncological outcomes were obtained from 12 studies (average follow-up 57.8 months), functional data from 26 studies (average follow-up 49.6 months), fertility information from 10 studies (average follow-up 55.8 months), and data on nonpalpable tumors from 11 studies (average follow-up 32.1 months). Oncological control appears to be excellent in studies that reported these outcomes. Presence of germ cell neoplasia in situ was controlled with adjuvant radiation in nearly all cases. Functional outcomes are also promising, as development of primary and compensated hypogonadism was rare. Semen parameters are poor preoperatively among men with benign and malignant testis tumors, with occasional decline after TSS. Frozen section analysis at the time of surgery appears to be very reliable, and the majority of nonpalpable tumors appear to be benign. Conclusions TSS is a safe and efficacious technique with regards to oncological control and postoperative hormonal function based on retrospective, noncontrolled studies. TSS avoids unnecessary removal of benign testicular tissue, and should be given serious consideration in cases of nonpalpable, small tumors under 2 cm. In cases of malignancy, TSS can safely avoid anorchia in men with bilateral tumors and in men with solitary testicles. The use of the operating microscope, while theoretically promising, does not necessarily lead to better outcomes, however data are limited.
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Affiliation(s)
- Jesse Ory
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Udi Blankstein
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Daniel C Gonzalez
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
| | - Aditya A Sathe
- College of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Joshua T White
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Carlos Delgado
- School of Medicine and Health Science, Tecnologico de Monterrey, Monterrey, Mexico
| | - John Reynolds
- Department of Health Informatics, Miller School of Medicine, University of Miami, Calder Memorial Library, Miami, FL, USA
| | - Keith Jarvi
- Department of Surgery, Division of Urology, University of Toronto, Toronto, ON, Canada
| | - Ranjith Ramasamy
- Department of Urology, Miller School of Medicine, University of Miami, Miami, FL, USA
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15
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Venditti M, Arcaniolo D, De Sio M, Minucci S. Preliminary Investigation on the Involvement of Cytoskeleton-Related Proteins, DAAM1 and PREP, in Human Testicular Disorders. Int J Mol Sci 2021; 22:ijms22158094. [PMID: 34360857 PMCID: PMC8347498 DOI: 10.3390/ijms22158094] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 02/07/2023] Open
Abstract
Herein, for the first time, the potential relationships between the cytoskeleton-associated proteins DAAM1 and PREP with different testicular disorders, such as classic seminoma (CS), Leydig cell tumor (LCT), and Sertoli cell-only syndrome (SOS), were evaluated. Six CS, two LCT, and two SOS tissue samples were obtained during inguinal exploration in patients with a suspect testis tumor based on clinical examination and ultrasonography. DAAM1 and PREP protein levels and immunofluorescent localization were analyzed. An increased DAAM1 protein level in CS and SOS as compared to non-pathological (NP) tissue was observed, while LCT showed no significant differences. Conversely, PREP protein level increased in LCT, while it decreased in CS and SOS compared to NP tissue. These results were strongly supported by the immunofluorescence staining, revealing an altered localization and signal intensity of DAAM1 and PREP in the analyzed samples, highlighting a perturbed cytoarchitecture. Interestingly, in LCT spermatogonia, a specific DAAM1 nuclear localization was found, probably due to an enhanced testosterone production, as confirmed by the increased protein levels of steroidogenic enzymes. Finally, although further studies are needed to verify the involvement of other formins and microtubule-associated proteins, this report raised the opportunity to indicate DAAM1 and PREP as new potential markers, supporting the cytoskeleton dynamics changes occurring during normal and/or pathological cell differentiation.
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Affiliation(s)
- Massimo Venditti
- Dipartimento di Medicina Sperimentale, Sez, Fisiologia Umana e Funzioni Biologiche Integrate “F. Bottazzi”, Università degli Studi della Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Napoli, Italy
- Correspondence: (M.V.); (S.M.)
| | - Davide Arcaniolo
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Napoli, Italy; (D.A.); (M.D.S.)
| | - Marco De Sio
- Dipartimento della Donna, del Bambino e di Chirurgia Generale e Specialistica, Università degli Studi della Campania “Luigi Vanvitelli”, Via Luigi De Crecchio 2, 80138 Napoli, Italy; (D.A.); (M.D.S.)
| | - Sergio Minucci
- Dipartimento di Medicina Sperimentale, Sez, Fisiologia Umana e Funzioni Biologiche Integrate “F. Bottazzi”, Università degli Studi della Campania “Luigi Vanvitelli”, Via Costantinopoli 16, 80138 Napoli, Italy
- Correspondence: (M.V.); (S.M.)
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16
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Hussain SA, Dubil EA, De Luca-Johnson JN, Johnston M. Occult symptomatic bilateral pure Leydig cell tumors in a postmenopausal woman: a case report. Gynecol Endocrinol 2021; 37:672-675. [PMID: 34137345 DOI: 10.1080/09513590.2021.1934443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Pure Leydig cell tumors (LCTs) represent 0.1% of ovarian masses. Postmenopausal patients typically present with virilization. Although LCTs can be challenging to locate on conventional imaging, positron emission tomography (PET) has been demonstrated to be effective. CASE A 64-year-old postmenopausal woman presented with alopecia, facial hirsutism, and clitoromegaly. Laboratory findings included elevated testosterone and androstenedione. Ultrasound, computed tomography, and magnetic resonance imaging showed no adnexal masses. PET did not demonstrate ovarian fludeoxyglucose-avidity. Histopathology after bilateral salpingo-oophorectomy revealed bilateral Leydig cell tumors. Her testosterone normalized 2 weeks postoperatively. CONCLUSION We describe the occult, symptomatic, bilateral ovarian Leydig cell tumors, an occurrence that has not been described in the literature. Virilizing tumors must be considered in patients with evidence of hyperandrogenism, even without pelvic masses on imaging.
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Affiliation(s)
- S Ahmed Hussain
- Department of Obstetrics and Gynecology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | - Elizabeth A Dubil
- Division of Gynecologic Oncology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
| | | | - Michael Johnston
- Division of Surgical Oncology, Naval Medical Center Portsmouth, Portsmouth, VA, USA
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17
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Mendonça F, Souto S, Magalhães D, Portugal R, Coelho AR, Fernandes AS, Falcão V, Tavares S, Portugal I, Beires J, Carvalho D. Hyperandrogenism, oligomenorrhea, and erythrocytosis caused by an ovarian Leydig cell tumor: A case report. Clin Case Rep 2021; 9:e04001. [PMID: 34026130 PMCID: PMC8117810 DOI: 10.1002/ccr3.4001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 12/09/2020] [Accepted: 01/02/2021] [Indexed: 12/31/2022] Open
Abstract
Leydig cell tumors are rare ovarian neoplasms. Affected individuals typically present with amenorrhea/oligomenorrhea and rapidly progressive features of virilization. Erythrocytosis can also occur as a result of high testosterone levels.
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Affiliation(s)
- Fernando Mendonça
- Serviço de Endocrinologia Diabetes e Metabolismo Centro Hospitalar e Universitário de S. João Porto Portugal.,Faculdade de Medicina da Universidade do Porto Porto Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
| | - Selma Souto
- Serviço de Endocrinologia Diabetes e Metabolismo Centro Hospitalar e Universitário de S. João Porto Portugal.,Faculdade de Medicina da Universidade do Porto Porto Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
| | | | - Raquel Portugal
- Serviço de Anatomia Patológica Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Ana Rita Coelho
- Serviço de Anatomia Patológica Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Ana Sofia Fernandes
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Vera Falcão
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Sara Tavares
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Inês Portugal
- Serviço de Radiologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Jorge Beires
- Serviço de Ginecologia Centro Hospitalar e Universitário de S. João Porto Portugal
| | - Davide Carvalho
- Serviço de Endocrinologia Diabetes e Metabolismo Centro Hospitalar e Universitário de S. João Porto Portugal.,Faculdade de Medicina da Universidade do Porto Porto Portugal.,i3S - Instituto de Investigação e Inovação em Saúde Universidade do Porto Porto Portugal
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18
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Oride A, Kanasaki H, Okada H, Kyo S. Detection of pure Leydig cell ovarian tumor not visible on imaging by selective venous blood sampling in a woman with secondary amenorrhea and hirsutism: A case report. Case Rep Womens Health 2021; 30:e00298. [PMID: 33665140 PMCID: PMC7903288 DOI: 10.1016/j.crwh.2021.e00298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 11/06/2022] Open
Abstract
A 39-year-old woman (gravida 1, para 1) was referred to a university hospital with a high serum testosterone level and secondary amenorrhea, hirsutism, and weight gain. Her voice was deep, and hirsutism was observed on her chin, arms, and back. She also had clitoromegaly. Her serum testosterone levels were markedly elevated (testosterone 11.1 ng/mL, free testosterone 15.5 pg/mL). Transvaginal ultrasonography and magnetic resonance imaging did not reveal any tumors in the pelvic organs, including the uterus and ovaries. Enhanced computed tomography revealed no abnormalities in either adrenal gland. Blood sampling from the inferior vena cava, left renal vein, and the ovarian veins on both sides revealed an extremely high testosterone level (391 ng/mL) in blood from the right ovarian vein. Laparoscopic right oophorectomy was performed and the pathologic diagnosis was a Leydig cell tumor (1.5 × 1.5 × 1.3 cm). Her serum testosterone level decreased rapidly following oophorectomy (0.3 ng/mL on postoperative day 2). Her menstrual cycle had recovered spontaneously by 2 months after surgery and she noticed improvement in the hirsutism 4 months after the operation. Sertoli–Leydig cell tumors are rare, accounting for less than 0.5% of all ovarian tumors. We report a case of a 39-year-old woman with hyperandrogenism caused by a pure Leydig cell tumor in one ovary. The tumor was not visible on imaging and was diagnosed with selective venous blood sampling. Following oophorectomy her symptoms resolved.
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Affiliation(s)
- Aki Oride
- Department of Obstetrics and Gynecology, School of Medicine, Shimane University, 89-1 Enya Cho, Izumo, Shimane 693-8501, Japan
| | - Haruhiko Kanasaki
- Department of Obstetrics and Gynecology, School of Medicine, Shimane University, 89-1 Enya Cho, Izumo, Shimane 693-8501, Japan
| | - Hiroe Okada
- Department of Obstetrics and Gynecology, School of Medicine, Shimane University, 89-1 Enya Cho, Izumo, Shimane 693-8501, Japan
| | - Satoru Kyo
- Department of Obstetrics and Gynecology, School of Medicine, Shimane University, 89-1 Enya Cho, Izumo, Shimane 693-8501, Japan
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Keefe DT, Blais AS, Rickard M, Yehia N, Chami R, Lorenzo AJ. Spermatogenesis in pre-pubertal boys with Leydig cell neoplasms suggests paracrine stimulation by testosterone. J Pediatr Urol 2021; 17:48.e1-6. [PMID: 33129671 DOI: 10.1016/j.jpurol.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/24/2020] [Accepted: 10/13/2020] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pediatric Leydig cell tumors (LCTs) represent approximately 4% of pre-pubertal testicular tumors and are known to cause precocious puberty secondary to testosterone production. While gonadotropins and testosterone are known to initiate spermatogenesis beginning in puberty, it is yet to be determined if a similar phenomenon is triggered by isolated testosterone production in prepubescent boys. OBJECTIVE To determine if testicular pathology in pre-pubertal pediatric patients with LCTs exhibit spermatogenesis secondary to paracrine testosterone stimulation. STUDY DESIGN We reviewed patients who underwent orchiectomy for a testicular tumor from 2003-17. We included patients with LCTs and compared them to children with non-LCT pathology (teratomas and epidermoid cysts). We excluded other pathologies and tumors in pubertal patients. Data were collected on the presence of spermatogenesis on pathology, tumor markers and serum hormone results. RESULTS Orchiectomy for testicular tumors were completed in 66 patients, of which 20 were included in the non-LCT group and 9 in the LCT group. Two of the 9 LCT patients had bilateral pathology. Age at presentation was 6.3 ± 5.8 years for the non-LCT group vs. 8.4 ± 1.6 years for LCTs (p = 0.261). Spermatogenesis was detected in 7 (64%) LCT specimens vs 2 (10%) non-LCT specimens (p = 0.002). Age of the spermatogenesis patients in the non-LCT group (11.08 ± 2.5 years) was older than LCT ones (8.3 ± 2.0 years), suggesting that spermatogenesis in the non-LCT group may be due to early pubertal development. The summary figure demonstrates spermatogenesis identified in a pre-pubertal LCT patient. DISCUSSION In this study, pre-pubertal males with LCTs were identified to have pathology evidence of spermatogenesis compared to controls with non-LCT pathology. This represents the first study assessing paracrine testosterone effects on spermatogenesis in pre-pubertal patients with LCTs. In contrast, adult literature on LCTs primarily report on resulting concerns for fertility, gynecomastia and testicular atrophy. CONCLUSION LCTs can induce spermatogenesis in prepubertal patients. This reinforces the hypothesis that paracrine testosterone signaling plays a role in spermatogenesis. Our findings could help explore novel fertility preservation opportunities in children.
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Shakir MK, Snitchler AN, Vietor NO, Mai VQ, Hoang TD. Bilateral Ovarian Leydig Cell Tumors in a Postmenopausal Woman Causing Hirsutism and Virilization. AACE Clin Case Rep 2020; 7:26-28. [PMID: 33851015 PMCID: PMC7924158 DOI: 10.1016/j.aace.2020.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Objective To evaluate a rare case of a postmenopausal woman with hirsutism and virilization due to Leydig cell tumors (LCTs) of both ovaries. Methods In this challenging case, the diagnostic studies included the detection of total/free testosterone, hemoglobin, and estradiol levels; adrenal computed tomography; and pelvic magnetic resonance imaging. Results A 61-year-old woman presented for the evaluation of hirsutism. Physical examination revealed normal vital signs and evidence of virilization. The baseline laboratory findings were hemoglobin level of 16.2 g/dL (reference, 12.0-15.5 g/dL), total testosterone level of 803 ng/dL (reference, 3-41 ng/dL), and free testosterone level of 20.2 pg/mL (reference, 0.0-4.2 pg/mL). Pelvic magnetic resonance imaging showed bilateral homogeneous ovarian enhancement. Based on the magnetic resonance imaging findings and clinical presentation, the patient was diagnosed with ovarian hyperthecosis and underwent laparoscopic bilateral oophorectomy. Pathology confirmed LCTs in both ovaries. Six months later, testosterone levels normalized, with significant improvement in hirsutism and virilization. Conclusion Clinicians should be aware of androgen-secreting tumors, including rare bilateral LCTs in postmenopausal women presenting with progressing hirsutism and virilization. Marked hyperandrogenemia with total testosterone level of >150 ng/dL (5.2 nmol/L) or serum dehydroepiandrosterone sulfate level of >700 μg/dL (21.7 mmol/L) is typically found. It should be recognized that diffuse stromal Leydig cell hyperplasia and small LCTs may be missed on imaging, and in some cases only pathology can confirm the result.
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Affiliation(s)
- Mohamed K.M. Shakir
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Andrea N. Snitchler
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Nicole O. Vietor
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Vinh Q. Mai
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
| | - Thanh D. Hoang
- Division of Endocrinology, Department of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
- Department of Pathology, Walter Reed National Military Medical Center, Bethesda, Maryland
- Address correspondence and reprint requests to Dr. Thanh D. Hoang, Division of Endocrinology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Bethesda, MD 20889.
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Cortés-Vázquez YD, Cortés-Vázquez AR, Sánchez-Coral MA, Priego-Niño A, Mercado-Vargas RZ, Castillo-Canto CO. Cáncer renal papilar tipo 2, asociado a piloleiomiomatosis y tumor testicular bilateral de células de Leydig. CIR CIR 2020; 88:94-98. [PMID: 33284259 DOI: 10.24875/ciru.20001487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
El 10-15 % de los tumores renales son tipo papilar, su asociación a síndromes hereditarios es poco frecuente y son muy agresivos. Se presenta el caso de un paciente con piloleiomiomatosis con tumor dependiente del riñón derecho y la glándula suprarrenal izquierda, y nefrectomía radical derecha con carcinoma renal papilar tipo 2. Recurrencia retroperitoneal, hepática y lesión testicular bilateral. Orquiectomía radical izquierda con tumor de células de Leydig, metastasectomía hepática y retroperitoneal con carcinoma papilar tipo 2, último estudio de seguimiento sin datos de actividad tumoral. el seguimiento oncológico con estudios no invasivos y los avances terapéuticos pueden mejorar las tasas de supervivencia. 10-15% of cases of renal tumors correspond to papillary type, the association to hereditary syndromes is rare, and aggressive. Clinical case: male with a history of piloleiomyomatosis and right kidney and left adrenal tumor, right radical nephrectomy with papillary renal carcinoma type 2. Development retroperitoneal, hepatic and bilateral testicular tumor. Left radical orchiectomy with Leydig cell tumor, hepatic and retroperitoneal metastasectomy with papillary carcinoma metastasis type 2, latest follow-up study without tumor activity. Oncological follow-up with non-invasive studies and therapeutic advances could improve survival rates.
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Affiliation(s)
- Yeniseik D Cortés-Vázquez
- Servicio de Urología, Unidad Médica de Alta Especialidad Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS), Puebla. México
| | | | - Marvin A Sánchez-Coral
- Servicio de Urología, Unidad Médica de Alta Especialidad Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS), Puebla. México
| | - Alejandro Priego-Niño
- Servicio de Urología, Unidad Médica de Alta Especialidad Manuel Ávila Camacho, Instituto Mexicano del Seguro Social (IMSS), Puebla. México
| | - Reyna Z Mercado-Vargas
- Servicio de Radiología e Imagen, IMSS, Unidad Médica de Alta Especialidad Manuel Ávila Camacho, Puebla. México
| | - Carlos O Castillo-Canto
- Departamento de Patología, Unidad Médica de Alta Especialidad Manuel Ávila Camacho, IMSS, Puebla. México
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22
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Ben Kridis W, Lajnef M, Khmiri S, Boudawara O, Slimen MH, Boudawara T, Khanfir A. Testicular leydig cell tumor revealed by hydrocele. Urol Case Rep 2020; 35:101520. [PMID: 33318945 PMCID: PMC7725736 DOI: 10.1016/j.eucr.2020.101520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023] Open
Abstract
Leydig cell tumor (LCT) is a rare testicular tumor with a low incidence accounting 3% of all testicule neoplasms. Due to its rarity, the natural history of LCT is poorly understood. Patients can present with atypical symptoms and endocrine disorders. The diagnosis of LCT is based on histological and immunohistochemical examination. We report a new case of leydig cell tumor in a 61-year-old man presenting with a left testis hydrocele. The patient underwent a left orchidectomy and the diagnosis of LCT was established. Even in front of a benign pathology such as hydrocele, exploration is necessary to detect any testicle tumor.
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Affiliation(s)
- Wala Ben Kridis
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Maissa Lajnef
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Souhir Khmiri
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Ons Boudawara
- Department of Pathology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Mourad Haj Slimen
- Department of Urology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Tahia Boudawara
- Department of Pathology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Afef Khanfir
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
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23
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Trahmono, Wahyudi I, Rodjani A, Situmorang GR, Marzuki NS. Precocious Pseudo-Puberty with Testicular Enlargement: Two Cases of Leydig Cell Tumor with Different Histopathological Results. Res Rep Urol 2020; 12:577-582. [PMID: 33262958 PMCID: PMC7695686 DOI: 10.2147/rru.s277216] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 11/02/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Leydig cell tumors (LCT) are the most common hormone-secreting testicular tumors; it is a rare cause for precocious pseudo-puberty in boys. The tumors secrete high amounts of testosterone. We present two cases of LCT in prepubertal boys presenting with precocious puberty. Case Reports Case 1. A 6-year-old boy was referred from the pediatric department with a diagnosis of precocious puberty. The patient had reported enlarged and painless swelling of the left testicle from a year ago. The puberty status of the patient was A1P3G4. Ultrasonography examination had found left testicular mass. Elective radical orchiectomy of the left testicle was performed. Histopathological analysis confirmed the diagnosis of benign LCT. Case 2. A 6-year-old boy presented with an enlarged left testicle for the last three months. Features of puberty were noted on the patient (appearance of pubic and facial hair). The puberty status of the patient was A1P3G3. Left testicle US had found homogenous, hypoechoic mass with calcification. Bone age had found increased bone maturation. Increased androgen hormones were detected through a blood test. Radical orchiectomy of the left testicle was performed. The histopathological examination showed malignant LCT. Conclusion Leydig cell tumors uncommonly occur in children. Prepubertal-aged boys presented with asymmetrical, firm, painless testicular enlargement with signs of puberty should be evaluated for LCT. Histopathological analysis is the mainstay of diagnosis and radical orchiectomy is the treatment of choice of LCT.
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Affiliation(s)
- Trahmono
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Irfan Wahyudi
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Arry Rodjani
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Gerhard Reinaldi Situmorang
- Department of Urology, Cipto Mangunkusumo Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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24
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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25
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Lambropoulos V, Theodorakopoulos A, Mouravas V, Pazarli E, Godosis D, Kepertis C, Anastasiadis K, Spyridakis I. Testis-Sparing Surgery for Non-Palpable Leydig Cell Tumors in Prepubertal Children. Pediatr Rep 2020; 12:86-92. [PMID: 33114483 DOI: 10.3390/pediatric12030020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/16/2020] [Indexed: 11/17/2022] Open
Abstract
Leydig cell tumor (LCT) is an infrequent stromal neoplasm of the testis with an incidence of less than 3% of all gonadal tumors in the general male population. Only 25% is found in prepubertal children, where Leydig cell tumors are always reported benign. The hospital records of two prepubertal male children, who underwent organ sparing surgery for testicular LCT the last five years, were retrospectively reviewed. In both of them, the lesion was incidentally found during a scrotal ultrasonography for testicular pain. The diagnosis of a benign LCT was based on the pre-operative physical examination and imaging (Ultrasound-US, Magnetic Resonance Imaging-MRI) as well as the negative tumor markers. A testicle-sparing procedure was decided and the pathologic examination of the surgical specimen confirmed the diagnosis. No tumor recurrence was noted on follow-up. Testis-sparing surgery provides the possibility of complete excision of such lesions and should be considered as the treatment of choice.
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26
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Kotula-Balak M, Gorowska-Wojtowicz E, Milon A, Pawlicki P, Tworzydlo W, Płachno BJ, Krakowska I, Hejmej A, Wolski JK, Bilinska B. Towards understanding leydigioma: do G protein-coupled estrogen receptor and peroxisome proliferator-activated receptor regulate lipid metabolism and steroidogenesis in Leydig cell tumors? Protoplasma 2020; 257:1149-1163. [PMID: 32180008 PMCID: PMC7329793 DOI: 10.1007/s00709-020-01488-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 02/12/2020] [Indexed: 06/10/2023]
Abstract
Leydig cell tumors (LCT) are the most common type of testicular stromal tumor. Herein, we investigate the G protein-coupled estrogen receptor (GPER) and peroxisome proliferator-activated receptor (PPAR) implication in regulation of lipid homeostasis including the expression of steroidogenesis-controlling molecules in clinical specimens of LCTs and tumor Leydig cells (MA-10). We showed the general structure and morphology of LCTs by scanning electron and light microscopy. In LCTs, mRNA and protein analyses revealed increased expression of GPER and decreased expression of PPARα, β, and γ. Concomitantly, changes in expression pattern of the lutropin receptor (LHR), protein kinase A (PKA), perilipin (PLIN), hormone sensitive lipase (HSL), steroidogenic acute regulatory protein (StAR), translocator protein (TSPO), HMG-CoA synthase, and reductase (HMGCS, HMGCR) were observed. Using MA-10 cells treated with GPER and PPAR antagonists (alone and in combination), we demonstrated GPER-PPAR-mediated control of estradiol secretion via GPER-PPARα and cyclic guanosine monophosphate (cGMP) concentration via GPER-PPARγ. It is assumed that GPER and PPAR can crosstalk, and this can be altered in LCT, resulting in a perturbed lipid balance and steroidogenesis. In LCTs, the phosphatidylinositol-3-kinase (PI3K)-Akt-mTOR pathway was disturbed. Thus, PI3K-Akt-mTOR with cGMP can play a role in LCT outcome and biology including lipid metabolism.
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Affiliation(s)
- M Kotula-Balak
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland.
- University Centre of Veterinary Medicine, University of Agriculture in Kraków, Mickiewicza 24/28, 30-059, Kraków, Poland.
| | - E Gorowska-Wojtowicz
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
| | - A Milon
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
| | - P Pawlicki
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
| | - W Tworzydlo
- Department of Developmental Biology and Invertebrate Morphology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
| | - B J Płachno
- Department of Plant Cytology and Embryology, Institute of Botany, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
| | - I Krakowska
- University Centre of Veterinary Medicine, University of Agriculture in Kraków, Mickiewicza 24/28, 30-059, Kraków, Poland
| | - A Hejmej
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
| | - J K Wolski
- nOvum Fertility Clinic, Bociania 13, 02-807, Warszawa, Poland
| | - B Bilinska
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Faculty of Biology, Jagiellonian University in Kraków, Poland, Gronostajowa 9, 30-387, Kraków, Poland
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27
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Duliban M, Gorowska-Wojtowicz E, Tworzydlo W, Rak A, Brzoskwinia M, Krakowska I, Wolski JK, Kotula-Balak M, Płachno BJ, Bilinska B. Interstitial Leydig Cell Tumorigenesis-Leptin and Adiponectin Signaling in Relation to Aromatase Expression in the Human Testis. Int J Mol Sci 2020; 21:ijms21103649. [PMID: 32455738 PMCID: PMC7279359 DOI: 10.3390/ijms21103649] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 05/07/2020] [Accepted: 05/15/2020] [Indexed: 12/11/2022] Open
Abstract
Although epidemiological studies from the last years report an increase in the incidences of Leydig cell tumors (previously thought to be a rare disease), the biochemical characteristics of that tumor important for understanding its etiology, diagnosis, and therapy still remains not completely characterized. Our prior studies reported G-protein coupled estrogen receptor signaling and estrogen level disturbances in Leydig cell tumors. In addition, we found that expressions of multi-level-acting lipid balance- and steroidogenesis–controlling proteins including peroxisome proliferator-activated receptor are altered in this tumor. In order to get deeper into the other molecular mechanisms that regulate lipid homeostasis in the Leydig cell tumor, here we investigate the presence and expression of newly-described hormones responsible for lipid homeostasis balancing (leptin and adiponectin), together with expression of estrogen synthase (aromatase). Samples of Leydig cell tumors (n = 20) were obtained from patients (31–45 years old) and used for light and transmission electron microscopic, western blotting, and immunohistochemical analyses. In addition, body mass index (BMI) was calculated. In tumor mass, abundant lipid accumulation in Leydig cells and various alterations of Leydig cell shape, as well as the presence of adipocyte-like cells, were observed. Marked lipid content and various lipid droplet size, especially in obese patients, may indicate alterations in lipid homeostasis, lipid processing, and steroidogenic organelle function in response to interstitial tissue pathological changes. We revealed significantly increased expression of leptin, adiponectin and their receptors, as well as aromatase in Leydig cell tumors in comparison to control. The majority of patients (n = 13) were overweight as indicated by their BMI. Moreover, a significant increase in expression of phospholipase C (PLC), and kinases Raf, ERK which are part of adipokine transductional pathways, was demonstrated. These data expand our previous findings suggesting that in human Leydig cell tumors, estrogen level and signaling, together with lipid status, are related to each other. Increased BMI may contribute to certain biochemical characteristics and function of the Leydig cell in infertile patients with a tumor. In addition, altered adipokine-estrogen microenvironment can have an effect on proliferation, growth, and metastasis of tumor cells. We report here various targets (receptors, enzymes, hormones) controlling lipid balance and estrogen action in Leydig cell tumors indicating their possible usefulness for diagnostics and therapy.
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Affiliation(s)
- Michal Duliban
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland; (M.D.); (M.B.); (B.B.)
| | - Ewelina Gorowska-Wojtowicz
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland; (M.D.); (M.B.); (B.B.)
- Correspondence: (E.G.-W.); (M.K.-B.)
| | - Waclaw Tworzydlo
- Developmental Biology and Invertebrate Morphology, Institute of Zoology and Biomedical Research, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland;
| | - Agnieszka Rak
- Department of Physiology and Toxicology of Reproduction, Institute of Zoology and Biomedical Research, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland;
| | - Malgorzata Brzoskwinia
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland; (M.D.); (M.B.); (B.B.)
| | - Izabella Krakowska
- University Centre of Veterinary Medicine, University of Agriculture in Krakow, Mickiewicza 24/28, 30-059 Krakow, Poland;
| | - Jan K. Wolski
- nOvum Fertility Clinic, Bociania 13, 02-807 Warszawa, Poland;
| | - Malgorzata Kotula-Balak
- University Centre of Veterinary Medicine, University of Agriculture in Krakow, Mickiewicza 24/28, 30-059 Krakow, Poland;
- Correspondence: (E.G.-W.); (M.K.-B.)
| | - Bartosz J. Płachno
- Department of Plant Cytology and Embryology, Institute of Botany, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland;
| | - Barbara Bilinska
- Department of Endocrinology, Institute of Zoology and Biomedical Research, Jagiellonian University in Krakow, Gronostajowa 9, 30-387 Krakow, Poland; (M.D.); (M.B.); (B.B.)
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28
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Stokkel L, van der Poel HG, Langbein SI, Kerst JM, de Jong J, van Rhijn BWG. A testosterone-producing Leydig cell tumor metastasis during hormonal treatment of prostate cancer. Urol Ann 2020; 12:180-183. [PMID: 32565659 PMCID: PMC7292439 DOI: 10.4103/ua.ua_38_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Accepted: 10/29/2019] [Indexed: 11/04/2022] Open
Abstract
We describe a patient with a testosterone-producing metastasis discovered during the follow-up of prostate cancer. The patient had a history of a Leydig cell tumor (LCT) in the right testicle for which he underwent radical orchiectomy at the age of 60 years. Within a year after orchiectomy, he was diagnosed with prostate cancer. He received a radical prostatectomy with pelvic lymph node dissection. Due to recurrent prostate cancer, he underwent salvage radiation to the prostatic fossa and pelvic lymph node stations with hormonal treatment for 3 years. After approximately 1.5 years of chemical castration, a significant increase in testosterone level occurred. Further, diagnostic evaluations and surgery revealed a testosterone-producing LCT metastasis in the retroperitoneum.
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Affiliation(s)
- Laura Stokkel
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Sigrun I Langbein
- Department of Urology, Zaans Medical Center, Zaandam, The Netherlands
| | - J Martijn Kerst
- Department of Medical Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Jeroen de Jong
- Department of Pathology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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29
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Fankhauser CD, Grogg JB, Hayoz S, Wettstein MS, Dieckmann KP, Sulser T, Bode PK, Clarke NW, Beyer J, Hermanns T. Risk Factors and Treatment Outcomes of 1,375 Patients with Testicular Leydig Cell Tumors: Analysis of Published Case Series Data. J Urol 2020; 203:949-56. [PMID: 31845841 DOI: 10.1097/JU.0000000000000705] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Leydig cell tumors are rare but they are the most common nongerm cell testicular tumors. Only limited evidence exists for reliably differentiating between benign and malignant Leydig cell tumors and for optimally managing the different types and stages of this rare disease. In this review we synthesize the available evidence on the clinical presentation and clinicopathological characteristics associated with Leydig cell tumor malignancy and management. MATERIALS AND METHODS We analyzed published case series data on Leydig cell tumors. The association between clinicopathological variables and the presence of metastatic disease was assessed using regression analyses. RESULTS We included 357 reports, reviewing available data from 1,375 patients (median age 34 years). Testis sparing surgery was performed in 463 patients. Local recurrence after testis sparing surgery occurred in 8 of 121 (7%) patients with available followup information. Metastases were found in 101 patients and were most often located in the retroperitoneal lymph nodes (60%), lungs (38%) and/or liver (29%). The multivariable models with or without multiple imputation predicting metastatic disease included older age, larger tumor size, presence of any adverse factor (larger tumor diameter, necrosis, angiolymphatic invasion, pleomorphism, high mitotic index, atypia) and any protective factor (Reinke crystals, lipofuscin pigments, gynecomastia) with model AUCs of 0.93. Durable remission after resection of metastases or use of platinum based chemotherapy was rarely seen. CONCLUSIONS Our risk tables using clinicopathological parameters can help identify patients with malignant tumors. These patients should undergo disease staging and be followed or receive further treatment. In some patients with metastatic disease surgical and systemic treatment might result in disease control.
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30
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Liang Z, He Z, Chen C, Zhang F, Li J, Wu J. Microscopic testicular sperm extraction or post-operative sperm reversal in functional Leydig cell tumor: case report. Transl Androl Urol 2019; 8:556-561. [PMID: 31807432 DOI: 10.21037/tau.2019.08.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Leydig cell tumors are rare testicular tumors in adults. Hormonal activity is found in 20% of the cases with endocrine abnormalities, which may result in azoospermia. The appropriate management to achieve oncologic control and simultaneously obtain sperm remains a challenge. A patient sought assistance with fertility after a diagnosis of azoospermia accompanied by unilateral suspected Leydig cell tumor. The patient underwent unilateral orchidectomy along with microscopic testicular sperm extraction (mTESE) for sperm identification. Rare teratospermia was found during mTESE, hormones tended to be normal, and sperm reversal appeared postoperatively. Postoperative semen examination revealed oligozoospermia, and the parameters decreased further after 3 months. The androgen rebound effect promoted sperm level over the baseline within 3 months after surgery. The anticipated sperm reversal postoperatively rather than mTESE during routine orchidectomy achieved sperm acquisition. This case particularly highlights the androgen rebound effect, which elevated the sperm level beyond baseline within 3 months after surgery. Sperm cryopreservation is thus strongly recommended 3 months postoperatively and no more than 4 months.
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Affiliation(s)
- Zhongyan Liang
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Zhanwang He
- Department of Reproductive Medicine Center, Ninghai Maternal and Child health Hospital, Ninghai 315600, China
| | - Chong Chen
- Department of Ultrasonography, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Fengbin Zhang
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jingping Li
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
| | - Jinggen Wu
- Reproductive Medicine Center, Department of Urology and Andrology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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31
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Biemer J, Pambuccian SE, Barkan GA. Fine needle aspiration diagnosis of metastatic Leydig cell tumor. Report of a case and review of the literature. J Am Soc Cytopathol 2019; 8:220-229. [PMID: 31272604 DOI: 10.1016/j.jasc.2019.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 02/07/2019] [Accepted: 02/10/2019] [Indexed: 10/27/2022]
Abstract
Leydig cell tumors are rare sex cord-stromal tumors that account for less than 1% of all testicular tumors. Less than 10% of these tumors show metastatic malignant behavior. Herein we present a case of metastatic malignant Leydig cell tumor in an iliac lymph node diagnosed on fine-needle aspiration (FNA) in a 70-year-old man. The patient was referred from an outside institution with lymphadenopathy and had a past medical history of lymphoplasmacytic lymphoma/Waldenström's macroglobulinemia and past surgical history of orchiectomy. An iliac lymph node FNA was performed demonstrating large discohesive plasmacytoid cells with indistinct cell borders; abundant and finely granular cytoplasm; round, eccentric nuclei with evenly distributed chromatin; and prominent nucleoli. The tumor cells were positive for inhibin and negative for calretinin and keratin leading to the diagnosis of metastatic malignant Leydig cell tumor. Review of the patient's history and of previous pathologic material, careful evaluation of cytomorphologic features, and the judicious use of immunohistochemistry can allow an accurate diagnosis of metastatic Leydig cell tumor.
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Affiliation(s)
- John Biemer
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Stefan E Pambuccian
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois
| | - Güliz A Barkan
- Department of Pathology and Laboratory Medicine, Loyola University Medical Center, Maywood, Illinois.
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Rocher L, Criton A, Gennisson JL, Creze M, Albiges L, Ferlicot S, Bellin MF, Izard V, Correas JM. Characterization of Testicular Masses in Adults: Performance of Combined Quantitative Shear Wave Elastography and Conventional Ultrasound. Ultrasound Med Biol 2019; 45:720-731. [PMID: 30600129 DOI: 10.1016/j.ultrasmedbio.2018.10.027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 10/19/2018] [Accepted: 10/22/2018] [Indexed: 06/09/2023]
Abstract
We prospectively evaluated the performance of combined shear wave elastography (SWE) and conventional ultrasound (US) for the characterization of 89 testicular focal masses. Testes were evaluated with B-mode, color Doppler and SWE measurements, locating a region of interest on the normal and pathologic parenchyma. Thirty-seven malignant tumors (MTs), 12 burned out tumors (BOTs), 28 Leydig cell tumors (LCTs), 2 dermoid cysts and other benign lesions were included. MTs + BOTs exhibited more microliths and macrocalcifications compared with benign lesions (p < 10-4). LCTs manifested mostly a dominant peripheral vascularization pattern compared with other lesions. MTs + BOTs were stiffer compared with benign lesions (p < 2 × 10-4) but with a moderate area under the receiver operating characteristic curve (AUROC) of 80%. By focusing on LCTs versus MTs + BOTs, diagnostic performance led to an AUROC of 89% for the best stiffness parameter. For combined conventional US and SWE, the diagnostic performance to differentiate all benign lesions versus MTs + BOTs and LCTs versus MTs + BOTs increased to AUROCs of 93% and 98%, respectively.
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Affiliation(s)
- Laurence Rocher
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France.
| | - Aline Criton
- Supersonic Imagine, Aix en Provence Cedex, France
| | - Jean-Luc Gennisson
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Maud Creze
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Laurence Albiges
- Paris South Medical University, Le Kremlin Bicêtre, France; Département d'Oncologie, Institut Gustave Roussy, Villejuif, France
| | - Sophie Ferlicot
- Paris South Medical University, Le Kremlin Bicêtre, France; Department of Pathology, Bicêtre University Hospital, Le Kremlin Bicêtre, France
| | - Marie-France Bellin
- Department of Adult Diagnostic and Interventional Radiology, Bicetre University Hospital, Le Kremlin Bicêtre, France; Paris South Medical University, Le Kremlin Bicêtre, France; Imagerie par Résonance Magnétique Médicale et Multi-Modalités, CNRS UMR8081, Université Paris Sud, CEA Service Hospitalier Frédéric Joliot, Orsay Cedex, France
| | - Vincent Izard
- Department of Urology, Bicetre University Hospital, Le Kremlin Bicêtre, France
| | - Jean-Michel Correas
- Institut Langevin, ESPCI Paris, PSL Research University CNRS UMR 7587, INSERM ERL U-979, Paris, France; Department of Adult Radiology, Necker University Hospital, Paris, France; Paris Descartes University, Paris, France
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Kawata R, Ii T, Hori T, Machida Y, Ochiai K, Azakami D, Ishiwata T, Michishita M. Leydig cell tumor in an Amur tiger (Panthera tigris altaica). J Vet Med Sci 2019; 81:186-189. [PMID: 30541983 PMCID: PMC6395220 DOI: 10.1292/jvms.18-0573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
A 14-year and 8-month-old intact male Amur tiger presented with an enlarged left testis,
measuring 5.7 × 5.5 × 4.5 cm. The cut surface was mottled dark red to reddish brown in
color. Microscopically, the enlarged left testis comprised round or polygonal neoplastic
cells arranged in a diffuse sheet pattern. These neoplastic cells had a hyperchromatic
nucleus and an abundant eosinophilic cytoplasm. Immunohistochemically, these neoplastic
cells were positive for vimentin, chromogranin A, synaptophysin, melan-A, inhibin-α, and
S100 and negative for desmin and WT-1. Based on these morphological and
immunohistochemical findings, the tumor was diagnosed as a Leydig cell tumor.
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Affiliation(s)
- Risako Kawata
- Department of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-8602, Japan
| | - Tatsuhito Ii
- Department of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-8602, Japan
| | - Tatsuya Hori
- Department of Veterinary Reproduction, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-8602, Japan
| | - Yukino Machida
- Department of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-8602, Japan
| | - Kazuhiko Ochiai
- Department of Basic Science, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-8602, Japan
| | - Daigo Azakami
- Department of Veterinary Nursing, School of Veterinary Nursing and Technology, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan
| | - Toshiyuki Ishiwata
- Division of Aging and Carcinogenesis, Research Team for Geriatric Pathology, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo 173-0015, Japan
| | - Masaki Michishita
- Department of Veterinary Pathology, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo 180-8602, Japan
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Abstract
This article provides a comprehensive review of non-germ cell tumors of the testis and paratestis in adults, incorporating the latest 2016 World Health Organization updates. Clinical features, gross pathologic findings, key morphologic details, immunohistochemical profiles, and differential diagnoses are covered, with an emphasis on how to resolve commonly encountered, and sometimes difficult, differential diagnoses.
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Affiliation(s)
- Kelly L Mooney
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA 94305, USA
| | - Chia-Sui Kao
- Department of Pathology, Stanford University School of Medicine, 300 Pasteur Drive, L235, Stanford, CA 94305, USA.
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Kuno Y, Baba T, Kuroda T, Teramoto M, Hirokawa N, Endo T, Saito T. Rare case of occult testosterone-producing ovarian tumor that was diagnosed by selective venous hormone sampling. Reprod Med Biol 2018; 17:504-508. [PMID: 30377407 PMCID: PMC6194242 DOI: 10.1002/rmb2.12213] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 05/21/2018] [Indexed: 11/16/2022] Open
Abstract
CASE A 32 year old woman was referred because of secondary amenorrhea, hirsutism, and voice deepening. OUTCOME The blood testosterone level was markedly high. A transvaginal ultrasound revealed a small region in the left ovary, but whether or not it was a tumor was unclear. Therefore, selective ovarian venous sampling was performed. Consequently, the testosterone level was selectively increased in a blood sample that was taken from the left ovarian vein, the tumor was successfully localized, and a laparoscopic left oophorectomy was performed. Although the left ovary appeared to be normal at laparoscopy, the androgen-secreting tumor was located within it. The tumor was diagnosed as a Leydig cell tumor by histopathological analyses. CONCLUSION This report demonstrates that selective blood sampling from ovarian veins before an operation is effective in localizing an androgen-producing ovarian tumor that is difficult to diagnose by imaging studies.
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Affiliation(s)
- Yoshika Kuno
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Tsuyoshi Baba
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Takafumi Kuroda
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Mizue Teramoto
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Naoki Hirokawa
- Department of Radiology Sapporo Medical University School of Medicine Sapporo Japan
| | - Toshiaki Endo
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
| | - Tsuyoshi Saito
- Department of Obstetrics and Gynecology Sapporo Medical University School of Medicine Sapporo Japan
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Abstract
PURPOSE Small benign testicular masses are often misinterpreted as germ cell tumors and immediate inguinal orchiectomy is performed. We analyzed the diagnostic and therapeutic workup of testicular masses to improve preoperative stratification algorithms. MATERIALS AND METHODS We performed a retrospective, single center analysis of the records of 522 patients diagnosed with primary testicular masses of unknown malignant potential. RESULTS A total of 28 patients (5%) showed a primary benign tumor after resection, including Leydig cell tumors in 9 (32%), epidermoid cysts in 9 (32%), adenomatoid tumors in 8 (29%) and Sertoli cell tumors in 2 (7%). The median volume of benign tumors was significantly less than that of malignant tumors (0.75 cm3, range 0.1 to 2.1 vs 15, range 4.5-39.9, p ≤0.001). At a cutoff of 2.8 cm3 tumor volume most accurately differentiated between benign and malignant disease, and it was a predictor of malignancy with 83% sensitivity and 89% specificity (OR 1.389, 95% CI 1.035-1.864, p = 0.029). Symptom duration in patients with benign tumors was significantly longer (365 days, range 25.5 to 365 vs 20, range 7 to 42, p ≤0.001). Also, tumor markers were unaltered in benign lesions. In patients with benign tumors significantly more fertility disorders or cryptorchidism were found (p ≤0.001) as well as a tendency toward lower testosterone (3.9 μg/l, range 0.9 to 4.9 vs 5.3, range 3.5 to 6.8, p = 0.084). Testis sparing surgery was performed in 22 of all patients (79%) with benign tumors. There was no case of relapse during followup. CONCLUSIONS Nongerm cell tumors should be considered when small testicular masses have a volume of less than 2.8 cm3 and there are hormone disorders or normal tumor markers. Immediate orchiectomy should be avoided, favoring testis sparing surgery.
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Affiliation(s)
- Pia Paffenholz
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - Linn Held
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - Sven H Loosen
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - David Pfister
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany
| | - Axel Heidenreich
- Department of Urology, University Hospital Cologne, Cologne, Germany; Department of Medicine III, University Hospital RWTH Aachen (SHL), Aachen, Germany.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Moura FS, Costa-Barbosa FA, Leao SC, Nicolau SM, Kater CE, Monteagudo PT. Confounder factors masking a Leydig-cell ovarian tumor in a post-menopausal woman treated for androgen-positive receptor breast cancer. Gynecol Endocrinol 2017; 33:675-679. [PMID: 28443693 DOI: 10.1080/09513590.2017.1318373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Post-menopause hyperandrogenism is a condition that needs careful evaluation. Aromatase inhibitors (AI), which are important in the management of positive estrogen breast cancer, and chronic kidney disease (CKD) can puzzle the evaluation of this condition. A postmenopause female with type-2 diabetes and advanced CKD was attended due to progressive virilization, which has started after the introduction of an AI for breast cancer 5 years earlier. Clinical and radiological investigation has confirmed a pure Leydig cell tumor as source of hyperandrogenism. Re-evaluation of the breast tumor immunohistochemistry has shown positive androgen receptor expression and negative expression for estrogen, progesterone and HER-2 receptors. Even though an ovarian tumor was the source of androgen excess, we discuss that AI could exert a slight contribution to patient's virilization by reducing estradiol counterbalance. Also, although the onset of hyperandrogenic symptoms was unclear, we could not exclude that the ovarian tumor had produced enough androgens to play a role in breast tumor progression. This case report supports the literature regarding the possible association between Leydig cell tumor and androgen-receptor-positive breast cancer development. Finally, progressive hyperandrogenic symptoms in postmenopause, even under AI therapy or the presence of advanced CKD, impose a more detailed investigation.
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Affiliation(s)
| | | | | | - Sergio Mancini Nicolau
- c Gynecology Division Department of Medicine, Universidade Federal de São Paulo , São Paulo , Brazil
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40
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Hibi H, Yamashita K, Sumitomo M, Asada Y. Leydig cell tumor of the testis, presenting with azoospermia. Reprod Med Biol 2017; 16:392-395. [PMID: 29259494 PMCID: PMC5715892 DOI: 10.1002/rmb2.12046] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 06/19/2017] [Indexed: 12/18/2022] Open
Abstract
Case A case of Leydig cell tumor, associated with azoospermia, is presented. Outcome The levels of sex hormones obviously were decreased, including luteinizing hormone (LH) and follicle‐stimulating hormone (FSH), with elevated testosterone. Computed tomography revealed no adrenal gland tumor, but a significant calcification in the right scrotal content was observed. He received a right radical orchiectomy and then he was unable to ejaculate. An endocrine panel revealed significantly decreased levels of testosterone and the low LH level had remained. Hormone replacement therapy with combined LH and FSH successfully recovered and preserved spermatogenesis. Conclusions Although the patient’s sexual function deteriorated after surgery, hormone replacement therapy was successful in establishing spermatogenesis.
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Affiliation(s)
- Hatsuki Hibi
- Department of Urology Kyoritsu General Hospital Nagoya Japan
| | - Kyoko Yamashita
- Department of Pathology and Biological Responses Nagoya University Graduate School of Medicine Nagoya Japan
| | - Makoto Sumitomo
- Department of Urology Aichi Medical University School of Medicine Nagakute Japan
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Muheilan MM, Shomaf M, Tarawneh E, Murshidi MM, Al-Sayyed MR, Murshidi MM. Leydig cell tumor in grey zone: A case report. Int J Surg Case Rep 2017; 35:12-16. [PMID: 28419904 PMCID: PMC5394201 DOI: 10.1016/j.ijscr.2017.03.043] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2017] [Revised: 03/31/2017] [Accepted: 03/31/2017] [Indexed: 11/12/2022] Open
Abstract
Leydig cell tumor is a testicular tumor with a low incidence accounting for 1–3% of testicular neoplasms. Only about 10% of them show malignant behavior in the form of metastatic disease. When diagnosed and treated early, long-term favorable outcomes are seen even with its potential metastatic behavior.
Introduction Leydig cell tumor constitutes only about 1–3% of testicular neoplasms. There is apparently increased incidence in the last few years; one possible explanation for this phenomenon is the widespread use of ultrasound technology and the subsequent increased early detection of smaller lesions that have not been found in historical series. Case presentation We report a case of Leydig cell tumor of testis in a patient presenting with painless long standing slowly growing left scrotal mass who found to have intrapulmonary nodule and multiple enlarged retroperitoneal lymph nodes on staging work up. The mass was managed by radical orchiectomy. Pathological diagnosis was Leydig cell tumor. Discussion Orchiectomy is the accepted mode of treatment but follow-up every 3–6 months with physical examination, hormone assays, scrotal and abdominal ultrasonography, chest radiography, and CT scans is essential in such a case with a potential for malignant behavior. Conclusion Inguinal orchiectomy is the therapeutic decision of choice and long-term follow-up is necessary to exclude recurrence or metastasis. Cases which fall in the grey zone like ours need to be followed up carefully for metastasis instead of rushing into an early retroperitoneal lymph node dissection, with its potential risks and complications.
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Affiliation(s)
- Muheilan Mustafa Muheilan
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Jordan.
| | - Maha Shomaf
- Department of Pathology and Microbiology and Forensic Medicine, Jordan University Hospital, The University of Jordan, Jordan.
| | - Emad Tarawneh
- Department of Radiology, Jordan University Hospital, The University of Jordan, Jordan.
| | | | - Manar Rizik Al-Sayyed
- Department of Pathology and Microbiology and Forensic Medicine, Jordan University Hospital, The University of Jordan, Jordan.
| | - Mujalli Mhailan Murshidi
- Division of Urology, Department of Special Surgery, Jordan University Hospital, The University of Jordan, Jordan.
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Zuiki T, Ohki J, Komatsubara T, Lefor AK, Miyahara Y, Ochi M, Hirota N. An inguinal hernia with cryptorchidism with a Leydig cell tumor in an elderly man: A case report. Int J Surg Case Rep 2017; 31:193-6. [PMID: 28171846 DOI: 10.1016/j.ijscr.2017.01.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 01/19/2017] [Accepted: 01/19/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Cryptorchidism is common in children but is rare in the elderly. It often presents with a constellation of signs and symptoms similar to routine inguinal hernias. We present the case of an elderly man with cryptorchidism containing a Leydig cell tumor and provide clinical insights. PRESENTATION OF CASE An-84-year old man was admitted with an incarcerated right lower quadrant hernia. Both testes were absent on palpation of the scrotum. After reduction of the hernia, computed tomography scan revealed a round lesion in the hernia sac, which was suspected to be the ectopic testis. Laparoscopic exploration was performed in combination with an open anterior approach. The hernia orifice was the right internal inguinal ring, and the inguinal canal was obliterated by adhesions because the spermatic cord did not pass through it. The ectopic testis was resected with the hernia sac, and the hernia repaired with a KUGEL™ patch (Bard, USA). DISCUSSION Laparoscopic exploration was useful to delineate the anatomy of this unusual inguinal hernia. The open anterior approach was necessary to dissect the ectopic testis and the hernia sac. Pathological findings revealed tumor cells with clear cytoplasm in the resected testis, diagnosed as a Leydig cell tumor. CONCLUSION The combination of laparoscopic and anterior approaches facilitated the surgical treatment of an unusual inguinal hernia with cryptorchidism. The resected ectopic testis should undergo thorough histopathologic examination.
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Emre S, Ozcan R, Elicevik M, Emir H, Soylet Y, Buyukunal C. Testis sparing surgery for Leydig cell pathologies in children. J Pediatr Urol 2017; 13:51.e1-51.e4. [PMID: 27773621 DOI: 10.1016/j.jpurol.2016.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Accepted: 08/01/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim was to analyze testis-sparing surgical procedures in boys with Leydig cell pathologies. STUDY DESIGN The hospital records of four boys with Leydig cell hyperplasia who underwent testis-sparing surgery for testicular masses between 2000 and 2012 were analyzed retrospectively. Tumor markers were evaluated and all boys underwent scrotal ultrasonography preoperatively. The hormonal profile was also analyzed for symptoms of precocious puberty. The testis was delivered through a high transverse inguinal incision and the tumor was excised by enucleation. After confirming the benign nature of the tumor with frozen-section examination, the testis was reinserted and fixed into the scrotum with absorbable sutures. All cases were followed-up with physical examination, scrotal ultrasonography, and measurement of β-human chorionic gonadotropin (HCG), α-fetoprotein, and hormone levels. RESULTS The mean age of the patients was 9.4 years (1.5-15 years). Testicular mass and scrotal asymmetry were detected in all cases. Ultrasonography was the main initial diagnostic modality for detecting testicular masses (Table). β-HCG and α-fetoprotein levels were normal. Three cases had Leydig cell hyperplasia and one patient was diagnosed to have a Leydig cell tumor. Signs of precocious puberty were detected in the four patients. The mean follow-up period was 4.8 years (2-8 years). Neither recurrence nor testicular atrophy developed in the follow-up. Findings of precocious puberty continued in one patient with Leydig cell hyperplasia, in whom a 2-mm contralateral metachronous lesion was detected and enucleated successfully. DISCUSSION Testis-sparing surgery with its potential long-term psychological, cosmetic, and functional advantages should be used in pediatric patients in whom a benign Leydig cell pathology is confirmed histopathologically. CONCLUSION This intervention with good long-term results can easily be applied through a proper dissection plane in the testicle. Since testicular Leydig cell tumors in childhood have small rates of recurrence, this choice of treatment is efficient in patients with salvageable testicular tissues and normal levels of tumor markers.
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Affiliation(s)
- Senol Emre
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey.
| | - Rahsan Ozcan
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Mehmet Elicevik
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Haluk Emir
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Yunus Soylet
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
| | - Cenk Buyukunal
- Department of Pediatric Surgery, Division of Pediatric Urology, Cerrahpasa Medical Faculty, Istanbul University, Istanbul, Turkey
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Abstract
According to the World Health Organization (WHO) classification Leydig cell tumors, Sertoli cell tumors and granulosa cell tumors of the testes belong to the group of sex cord-stromal tumors. These tumors most frequently occur sporadically but in rare cases can be associated with syndromes. These tumor entities show characteristic morphological changes, which in combination with specific immunohistochemical markers facilitate the diagnosis. Recent results of molecular pathological investigations, especially beta-catenin mutation analysis, allow a better categorization of these tumor entities.
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Affiliation(s)
- F Bremmer
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Str.40, 37075, Göttingen, Deutschland.
| | - S Schweyer
- Gemeinschaftspraxis Pathologie Starnberg, Am Fuchsengraben 3, 82319, Starnberg, Deutschland.
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Farjanikish G, Oryan A. Leydig cell tumor in ovary of a German Shepherd bitch: An immunohistopathological study. Vet Res Forum 2017; 8:81-84. [PMID: 28473902 PMCID: PMC5413316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Accepted: 08/09/2016] [Indexed: 11/19/2022]
Abstract
Leydig cell tumor as a sex-cord stromal tumor is a relatively uncommon ovarian tumor in bitch. A 10-year-old female German Shepherd dog was presented because of protrusion of a large tumor-like mass of 16 × 14 × 7 cm in dimensions from her vagina. After stabilization of the patient, the mass was removed surgically and concurrent ovariohysterectomy was also performed. Macroscopically, the healthy tissue of the right ovary was totally replaced by a homogeneous, brown and firm mass. The neoplasm was well-circumscribed and nodular and it was clearly demarcated from the healthy tissue. Histological examination revealed the presence of solid sheets and acinar structures composed of polyhedral to elongated cells. The neoplastic cells had large, eosinophilic, and vacuolated cytoplasms with round to oval nuclei and expressed vimentin on immunohistochemical examination. These gross, microscopic and immuno-histochemical features are characteristics of ovarian Leydig cell tumor.
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Affiliation(s)
- Ghasem Farjanikish
- Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran; ,Correspondence: Ghasem Farjanikish. DVM, PhD, Department of Pathobiology, Faculty of Veterinary Medicine, Lorestan University, Khorram Abad, Iran. E-mail:
| | - Ahmad Oryan
- Department of Pathobiology, School of Veterinary Medicine, Shiraz University, Shiraz, Iran.
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Prasivoravong J, Barbotin AL, Derveaux A, Leroy C, Leroy X, Puech P, Mitchell V, Marcelli F, Rigot JM. Leydig cell tumor of the testis with azoospermia and elevated delta4 androstenedione: case report. Basic Clin Androl 2016; 26:14. [PMID: 27833751 PMCID: PMC5100078 DOI: 10.1186/s12610-016-0041-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 09/14/2016] [Indexed: 12/27/2022] Open
Abstract
Background Secreting interstitial cell (Leydig cell) tumors are rare. In adults, the clinical picture and steroid levels are variable. Case presentation This paper presents a case of left testicular tumor, showing azoospermia with normal serum level of total testosterone, collapsed FSH and LH, and high delta4 androstenedione. Histopathological investigation revealed a Leydig cell tumor. TESE allowed spermatozoa extraction and freezing. Testicular histology found hypospermatogenesis and germ-cell aplasia with interstitial fibrosis. Surgical resection of the tumor resulted in normalization of gonadotropins and fall in serum delta4 androstenedione to subnormal levels in the postoperative period confirming that the tumor was secreting delta4 androstenedione. It was hypothesized that high delta4 androstenedione resulted in intra tumoral 17 β-HSD overtaken by delta4 androstenedione or that 17 β-HSD activity in the tumor was different from that of normal Leydig cells. Three months after surgery sperm analysis found a complete recovery of spermatogenesis. A spontaneous pregnancy occurred 3 months after surgery and a girl was born. Conclusions In this case, the diagnosis of testicular Leydig cell tumor secreting delta4 androstenedione was made in a context of azoospermia.
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Affiliation(s)
- J Prasivoravong
- Department of Andrology, Lille University Hospital, Lille, France ; Department of Andrology, CHRU Lille, Hôpital Calmette, Boulevard du Professeur Leclercq, 59037 Lille Cedex, France
| | - A-L Barbotin
- Biology of Reproduction Unit, Lille University Hospital, Lille, France ; EA4308 Gametogenesis and Gamete Quality, University of Lille, Lille, France
| | - A Derveaux
- Department of Andrology, Lille University Hospital, Lille, France
| | - C Leroy
- Department of Andrology, Lille University Hospital, Lille, France
| | - X Leroy
- Department of Pathology, Lille University Hospital, Lille, France
| | - P Puech
- Department of Radiology, Lille University Hospital, Lille, France
| | - V Mitchell
- Biology of Reproduction Unit, Lille University Hospital, Lille, France ; EA4308 Gametogenesis and Gamete Quality, University of Lille, Lille, France
| | - F Marcelli
- Department of Andrology, Lille University Hospital, Lille, France ; EA4308 Gametogenesis and Gamete Quality, University of Lille, Lille, France
| | - J-M Rigot
- Department of Andrology, Lille University Hospital, Lille, France ; EA4308 Gametogenesis and Gamete Quality, University of Lille, Lille, France
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Chapin RE, Ball DJ, Radi ZA, Kumpf SW, Koza-Taylor PH, Potter DM, Mark Vogel W. Effects of the Janus Kinase Inhibitor, Tofacitinib, on Testicular Leydig Cell Hyperplasia and Adenoma in Rats, and on Prolactin Signaling in Cultured Primary Rat Leydig Cells. Toxicol Sci 2016; 155:148-156. [PMID: 27708194 DOI: 10.1093/toxsci/kfw197] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Tofacitinib is an oral Janus kinase (JAK) inhibitor for the treatment of rheumatoid arthritis. Tofacitinib preferentially inhibits receptor signaling through JAK3 and JAK1, relative to JAK2. In the 2-year rat carcinogenicity study, there were tofacitinib, dose-related increases in the incidences of testicular Leydig cell hyperplasia and benign adenomas in male rats, and decreased incidences of mammary tumors and duct dilatation/galactocele in female rats. Such findings in rats are typical of agents, such as dopamine agonists, which decrease prolactin (PRL) activity. Since prolactin signals through the JAK2 pathway, we hypothesized that these findings were off-target effects due to inhibition of PRL signaling via JAK2. The studies reported here were designed to investigate the interruption of PRL signaling pathways in Leydig cells. In isolated primary rat Leydig cells, PRL increased phosphorylated Signal Transducer and Activator of Transcription-5 protein, and mRNA levels for luteinizing hormone receptor. Tofacitinib, at concentrations observed in the rat carcinogenicity study, dose-dependently inhibited these effects. These observations illustrate a novel mechanism, the inhibition of prolactin signaling by which modulation of JAK activity can modulate PRL signaling pathways to induce Leydig cell tumors in rats. Since human Leydig cells lack this PRL dependence for normal function, these rodent tumors do not indicate a health risk to human patients.
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Affiliation(s)
- Robert E Chapin
- Pfizer Drug Safety R&D, Eastern Point Rd, Groton, Connecticut 06340 .,Pfizer Drug Safety R&D, Eastern Point Rd, Groton, Connecticut 06340
| | - Douglas J Ball
- Pfizer Drug Safety R&D, Eastern Point Rd, Groton, Connecticut 06340
| | - Zaher A Radi
- Pfizer Drug Safety R&D, 1 Burtt Rd, Andover, Massachusetts 08010
| | - Steven W Kumpf
- Pfizer Drug Safety R&D, Eastern Point Rd, Groton, Connecticut 06340
| | | | - David M Potter
- Pfizer Drug Safety R&D, Eastern Point Rd, Groton, Connecticut 06340
| | - W Mark Vogel
- Pfizer Drug Safety R&D, 610 Main St, Cambridge, Massachusetts 02139
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Pozza C, Gianfrilli D, Fattorini G, Giannetta E, Barbagallo F, Nicolai E, Cristini C, Di Pierro GB, Franco G, Lenzi A, Sidhu PS, Cantisani V, Isidori AM. Diagnostic value of qualitative and strain ratio elastography in the differential diagnosis of non-palpable testicular lesions. Andrology 2016; 4:1193-1203. [PMID: 27565451 PMCID: PMC5108442 DOI: 10.1111/andr.12260] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Revised: 06/11/2016] [Accepted: 07/10/2016] [Indexed: 12/21/2022]
Abstract
The purpose of this study was to evaluate prospectively the accuracy of qualitative and strain ratio elastography (SE) in the differential diagnosis of non‐palpable testicular lesions. The local review board approved the protocol and all patients gave their consent. One hundred and six patients with non‐palpable testicular lesions were consecutively enrolled. Baseline ultrasonography (US) and SE were correlated with clinical and histological features and ROC curves developed for diagnostic accuracy. The non‐palpable lesions were all ≤1.5 cm; 37/106 (34.9%) were malignant, 38 (35.9%) were benign, and 31 (29.2%) were non‐neoplastic. Independent risk factors for malignancy were as follows: size (OR 17.788; p = 0.002), microlithiasis (OR 17.673, p < 0.001), intralesional vascularization (OR 9.207, p = 0.006), and hypoechogenicity (OR, 11.509, p = 0.036). Baseline US had 89.2% sensitivity (95% CI 74.6–97.0) and 85.5% specificity (95% CI 75.0–92.8) in identifying malignancies, and 94.6% sensitivity (95% CI 86.9–98.5) and 87.1% specificity (95% CI 70.2–96.4) in discriminating neoplasms from non‐neoplastic lesions. An elasticity score (ES) of 3 out of 3 (ES3, maximum hardness) was recorded in 30/37 (81.1%) malignant lesions (p < 0.001). An intermediate score of 2 (ES2) was recorded in 19/38 (36.8%) benign neoplastic lesions and in 22/31 (71%) non‐neoplastic lesions (p = 0.005 and p = 0.001 vs. malignancies). None of the non‐neoplastic lesions scored ES3. Logistic regression analysis revealed a significant association between ES3 and malignancy (χ2 = 42.212, p < 0.001). ES1 and ES2 were predictors of benignity (p < 0.01). Overall, SE was 81.8% sensitive (95% CI 64.8–92.0) and 79.1% specific (95% CI 68.3–88.4) in identifying malignancies, and 58.6% sensitive (95% CI 46.7–69.9) and 100% specific (95% CI 88.8–100) in discriminating non‐neoplastic lesions. Strain ratio measurement did not improve the accuracy of qualitative elastography. Strain ratio measurement offers no improvement over elastographic qualitative assessment of testicular lesions; testicular SE may support conventional US in identifying non‐neoplastic lesions when findings are controversial, but its added value in clinical practice remains to be proven.
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Affiliation(s)
- C Pozza
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - D Gianfrilli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - G Fattorini
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - E Giannetta
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - F Barbagallo
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | | | - C Cristini
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - G B Di Pierro
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - G Franco
- Department of Urology, Sapienza University of Rome, Rome, Italy
| | - A Lenzi
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - P S Sidhu
- Department of Radiology, King's College Hospital, London, England
| | - V Cantisani
- Department of Radiologic Science, Sapienza University of Rome, Rome, Italy
| | - A M Isidori
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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Shaw NM, Stauffer C, Eisenberg ML. Leydig cell tumor found incidentally during microscopic testicular sperm extraction in patient with mosaic Klinefelter syndrome: case report. Fertil Steril 2016; 106:1344-7. [PMID: 27523297 DOI: 10.1016/j.fertnstert.2016.07.1116] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 07/13/2016] [Accepted: 07/26/2016] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To report the finding and management of a case of Leydig cell tumor discovered during the infertility evaluation of a patient with mosaic Klinefelter syndrome. DESIGN Single case report. SETTING Academic hospital. PATIENT(S) Patient seeking assistance with fertility after a diagnosis of mosaic Klinefelter syndrome. INTERVENTION(S) The patient underwent microscopic testicular sperm extraction (mTESE) for sperm identification after the diagnosis of mosaic Klinefelter syndrome. Abnormal testicular tissue was identified during mTESE and histologically confirmed to be a Leydig cell tumor. The patient was informed of this incidental discovery and later underwent orchiectomy for conservative oncologic control. MAIN OUTCOME MEASURE(S) Histologic testicular assessment. RESULT(S) Patient was found to have no viable sperm on mTESE, but achieved oncologic control with bilateral orchiectomy. CONCLUSION(S) The presented case emphasizes the importance of awareness and expedient appropriate management to achieve oncologic control of a rare tumor with low malignant potential discovered during otherwise routine mTESE. In particular, it highlights the role of the infertility specialist in aiding in diagnosis and treatment of incidental and rare findings.
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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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