[Leydig cell tumor of the testis]

Abstract

Objective: To review our experience with Leydig cell tumor of the testis and compare our findings with those reported in the literature.

Methods: The clinical records of patients with Leydig cell tumor of the testis that were treated in our hospital were reviewed. This study analyzed patient age, reason for consultation, previous history of testicular pathology, size and location of the tumor, US pattern, histological findings, hormone analysis, semen analysis, treatment and clinical course.

Results: 7 patients had Leydig cell tumor of the testis, accounting for 2.1% of the testicular tumors treated in our hospital. The mean age at the time of diagnosis was 40 years. The presenting features were enlarged testis, gynecomastia, sexual dysfunction or incidental finding during testicular US assessment for cryptorchidism. Most of the tumors were hypoechoic and showed hypervascularization. Hormone analysis was abnormal in 4 patients and showed reduced testosterone and increased serum estradiol levels. The initial semen analysis showed azoospermia, severe oligozoospermia or cryptozoospermia in 4 patients. Six patients had previously undergone orchidectomy via the inguinal approach and one patient had undergone tumor resection. At 41 months mean follow-up, the tumor has been demonstrated to be benign.

Conclusions: Leydig cell tumor of the testis usually presents as a testicular mass, accompanied or preceded by hormonal changes in 20% of the cases, with feminization in the adult and masculinization in the child. The lesions are always benign in children and in 90% of the adult patients. The US features are usually hypoechoic. The histological criteria for malignancy do not always correlate with the clinical features. Malignancy is established by the presence of metastasis at the time of diagnosis or during follow-up. There is currently no effective treatment for the metastasis. Following orchidectomy, the clinical hormonal manifestations return/remit in 90% of the cases.