Leydig Cell Tumors



Leydig Cell Tumors


Steven S. Shen, MD, PhD

Mahul B. Amin, MD

Jae Y. Ro, MD, PhD










LCT is often a well-circumscribed mass with a homogeneous yellow-tan cut surface. Focal cystic change image is present. Hemorrhage or necrosis is lacking. LCT often do not replace the entire testis.






LCT is composed of broad cords of tumor cells separated by paucicellular and edematous fibrous stroma. The tumor cells have uniform, round to ovoid nuclei and abundant eosinophilic cytoplasm.


TERMINOLOGY


Abbreviations



  • Leydig cell tumor (LCT)


Synonyms



  • Interstitial cell tumor


Definitions



  • Pure testicular stromal tumor composed of cells that recapitulate normal interstitial Leydig cells


CLINICAL ISSUES


Epidemiology



  • Incidence



    • Most common type of sex cord stromal tumor (1-3% of testicular neoplasms)


  • Age



    • Occurs in any age with 2 peaks: 5-10 & 30-35 years


Presentation



  • Testicular enlargement, usually painless, decreased libido (20%), gynecomastia (15%), undescended testis (10%), or precocious puberty


  • May produce testosterone, androstenedione, and dehydroepiandrosterone


  • May be associated with cryptorchidism, testicular atrophy, infertility


  • Bilaterality in 3% of cases


Treatment



  • Surgical approaches



    • Orchiectomy is curative in majority of tumors; baseline staging work-up is required


    • Retroperitoneal lymph node dissection may be required in older patients and those with tumors with unfavorable histology


    • Testis-sparing surgery possible for young men


Prognosis



  • Majority have benign behavior


  • Approximately 10% malignant and may metastasize


MACROSCOPIC FEATURES


General Features



  • Well-circumscribed, intraparenchymal mass with golden-brown to yellow, or gray-white homogeneous cut surface


  • Focal hemorrhage or necrosis may be seen (25%)


  • Most confined within testis; extratesticular extension possible (10%)


Size



  • Range: 1-10 cm (average: 3 cm)


MICROSCOPIC PATHOLOGY


Histologic Features



  • Growth patterns: Solid (most common), insular, tubular, ribbon-like, and pseudofollicular


  • Large, round or polygonal cells with well-defined cell borders, eosinophilic or vacuolated cytoplasm


  • Relatively uniform round or ovoid nuclei, prominent nucleoli; focal nuclear pleomorphism (including endocrine-type), binucleated, or multinucleated cells may be seen


  • Cytoplasmic vacuoles or foamy cytoplasm (lipid content), lipofuscin (15%), and Reinke crystals (30-40%) may be seen


  • Frequent fibrous, hyalinized, edematous or myxoid stroma


  • Other uncommon features: Fatty metaplasia; spindle, clear cell, or microcystic changes; myxoid degeneration; calcification or ossification; and rhabdoid features



  • Features that tend to be seen more often in malignant tumors: Large tumor size (> 5 cm), infiltrative margins, vascular invasion, nuclear atypia, necrosis, high mitotic rate (> 3/10 high-power fields)


Cytologic Features



  • Large, round or polygonal cells with prominent nucleoli, abundant eosinophilic cytoplasm, and well-defined cell borders


Predominant Pattern/Injury Type



  • Diffuse and solid neoplastic growth

Jul 7, 2016 | Posted by in PATHOLOGY & LABORATORY MEDICINE | Comments Off on Leydig Cell Tumors
Premium Wordpress Themes by UFO Themes
%d bloggers like this: