Leydig cell tumour

Leydig cell tumour
Other names	Testicular interstitial cell tumour
Histopathology of a Leydig cell tumor, high magnification, H&E stain, showing typical features.[1]
Specialty	Oncology, endocrinology

Leydig cell tumour, also Leydig cell tumor (US spelling), (testicular) interstitial cell tumour and (testicular) interstitial cell tumor (US spelling), is a member of the

A Sertoli–Leydig cell tumour is a combination of a Leydig cell tumour and a Sertoli cell tumour from Sertoli cells.

Presentation

The majority of Leydig cell tumors are found in males, usually at 5–10 years of age or in middle adulthood (30–60 years). Children typically present with precocious puberty.^{[citation needed]}

Due to excess

In men, testicular swelling is the most common presenting feature. Other symptoms depend on age and the type of tumour. If it is secreting androgens the tumour is usually asymptomatic, but can cause precocious puberty in pre-pubertal boys. If the tumour secretes oestrogens it can cause feminisation in young boys. In adults, this causes a number of problems including gynaecomastia, erectile dysfunction, infertility, feminine hair distribution, gonadogenital atrophy, and a loss of libido.^[3]

Cause

Animal studies a suggest possible link with C8 (C₈HF₁₅O₂, perfluorooctanoic acid). ^[4]

Diagnosis

Presence of an ovarian tumour plus hormonal disturbances suggests a Leydig cell tumour, granulosa cell tumour or thecoma. However, hormonal disturbances, in Leydig tumours, is present in only 2/3 of cases. Testicular Leydig cell tumours can be detected sonographically, ultrasound examinations may be ordered in the event of a palpable scrotal lump, however incidental identification of these lesions is also possible.^[5]

A conclusive diagnosis is made via

The usual chemotherapy regimen has limited efficacy in tumours of this type, although imatinib has shown some promise.^[7] There is no current role for radiotherapy.^[8]

The usual treatment is surgery. The surgery for females usually is a fertility-sparing unilateral salpingo-oophorectomy. For malignant tumours, the surgery may be radical and usually is followed by adjuvant chemotherapy, sometimes by radiation therapy. In all cases, initial treatment is followed by surveillance. Because in many cases Leydig cell tumour does not produce elevated tumour markers,^[9] the focus of surveillance is on repeated physical examination and imaging.

In males, a radical inguinal orchiectomy is typically performed. However, testes-sparing surgery can be used to maintain fertility in children and young adults. This approach involves an inguinal or scrotal incision and ultrasound guidance if the tumour is non-palpable. This can be done because the tumour is typically unifocal, not associated with precancerous lesions, and is unlikely to recur.^[10]

The

• 
  Intermediate magnification micrograph of a Leydig cell tumour. H&E stain.
• 
  High magnification micrograph of a Leydig cell tumour. H&E stain.
• 
  Typical gross pathology of a Leydig cell tumor (in this case of the ovary): A well circumscribed, solid homogeneous mass with golden brown to brownish green cut surface.^[12]

See also

• Androgen-dependent syndromes
• Sertoli cell tumour
• Sertoli–Leydig cell tumour

References