|Year : 2004 | Volume
| Issue : 2 | Page : 166
Leydig cell tumor of the testis - a case report
Vishwajeet Singh, Himanshu Chaudhary, Aneesh Srivastava
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
Department of Urology and Renal Transplantation, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow - 226 014
Keywords: Testicular neoplasm, Leydig cell tumor.
|How to cite this article:|
Singh V, Chaudhary H, Srivastava A. Leydig cell tumor of the testis - a case report. Indian J Urol 2004;20:166
| Case Report|| |
A 24-year-old patient presented with a painless swelling in the left testis for 4 months. There was no other associated symptom. His general physical and abdominal examinations were normal. The left testicular examination revealed a 2 cm hard, smooth, nontender swelling at the upper pole which was separate from the epididymis. The testicular sensation was preserved. Examination of the right testis was normal. His routine investigations such as hemogram, renal function tests, liver function tests and urinalysis were normal. Serum alpha feto protein was 1.79 ng/ml (normal <10 ng/ml), b-hCG 0.5 mIU/ml (normal <5 mIU/ml) and LDH was 25 mIU/ml (normal <150 mIU/ ml). Chest X-ray was unremarkable. Ultrasound of the scrotum revealed a 3 x 2 cm intratesticular heterogenous mass at the upper pole of left testis and the right testis was normal. Spiral CT of the abdomen, pelvis and scrotum showed a 2 x 2 cm intratesticular heterogenous enhancing mass at the upper pole of left testis with normal right testis and normal retroperitoneum.
The patient underwent left high inguinal orchiectomy. The cut section of testicular specimen revealed a gritty sensation and a well circumscribed intratesticular mass. The histopathological examination of the specimen was reported as leydig cell tumor. The tumor was 2.5 x 2.5 cm encapsulated, composed of small clusters of round to polygonal cells with central nuclei and prominent nucleoli with eosinophilic cytoplasm [Figure - 1]. The mitotic figures were not discernible. Foci of calcification and hyalinization were present. The adjacent testis showed normal spermatogenesis. This patient was doing well at 3-years' follow-up with no evidence of metastasis.
| Comments|| |
Leydig cell tumor of testis are rare; comprise only 13% of testicular neoplasms. ,, Although majority are benign but a malignant course is reported in 10% of the cases. ,, The mean age for benign and malignant leydig cell tumors are 48 and 62.1 years respectively.  About 300-400 cases have been reported in literature.  Testicular swelling is the commonest presentation but 20% of cases can present with endocrine symptoms.  Benign leydig cell tumor can occur at any age (2-90 years), but the average age is 36 years.  The histopathological criteria for malignant leydig cell tumor have been described in literature.  These are (a) numerous and atypical mitoses, i (b) marked cellular pleomorphism with atypical neuclei, (c) necrosis, (d) angiolymphatic invasions, (e) tumor size >5 cm, (f) extension of the tumor into the spermatic cord or invasion of the capsule, (g) mitotic figures >3/10 hpf. While differentiating between benign and malignant leydig cell tumors, the presence of metastasis is the most accepted criterion for malicnancy. ,, Metastases have been reported as long as 8 and 17 years later. , Our case is only 24 years old, had presented with a testicular swelling, with no endocrine manifestations and had none of the histopathological features suggestive of malignancy. The patient is doing well and there is no evidence of metastasis at the 3 years' follow-up.
| References|| |
|1.||Gulbahce HE, Lindeland AT, Engel W, Lillemoe TJ. Metastic leydig cell tumor with sarcomatoid differentiation. Arch Pathol Lab Med 1999; 23: 1104-7. |
|2.||Cheville JC, Sebo TL Lager DJ, Bostwick DG, Farrow GM. Leydig cell tumor of the testis. A clinicopathologic, DNA content and MIB-1 comparison of non-metastasing and metastasing tumors. Am J Surg Pathol 1998; 22: 1361-7. |
|3.||Powari M, Kakkar N. Singh SK, Rai RS, Jogai S. Malignant leydig cell tumor of the testis. Urol Int 2002; 68: 63-5. |
[Figure - 1]