Retroperitoneal lymph node dissection (RPLND) for malignant phenotype Leydig cell tumours of the testis: a 10-year experience

Abstract

Retroperitoneal lymph node dissection (RPLND) is a prognostic, palliative, and potentially therapeutic procedure for patients with malignant phenotype Leydig cell tumours of the testis. We reviewed the records of patients diagnosed with malignant phenotype Leydig cell tumours of the testis treated by RPLND. Modified template dissection was performed in all cases with extra-template excision of tumour mass in Stage II disease. Routine clinico-radiological follow-up was performed. Six open RPLNDs (1 re-do procedure) were performed on 5 patients diagnosed with Stage I (n = 3) and Stage II (n = 2) malignant phenotype Leydig cell tumour of the testis. Median age = 63 years (range = 55-72). Median peri-operative blood loss = 1500 ml (range = 500-1500 ml). Median operating time = 6 h (range = 4.5-6.5). Two patients with Stage II disease developed post-operative complications of acute kidney injury (n = 1) and pneumonia (n = 1). Median length of stay was 8 days (range = 6-11). RPLND specimens from patients with Stage I were tumour-free, whilst patients with Stage II disease had evidence of metastatic tumour. At latest follow-up (median = 13 months, range = 7-22), no patient with Stage I disease had radiological evidence of recurrence, however the two patients with Stage II disease had died due to tumour recurrence at 13 months and 36 months. RPLND for malignant phenotype Leydig cell testicular tumours appears to be well tolerated. Despite surgery, overall outcomes for Stage II appear to be poor due to the disease phenotype. Larger prospective multi-centre studies are required to determine the definitive criteria for surgery in Stage I disease.

Keywords: Leydig cell tumour; Retroperitoneal lymph node dissection (RPLND); Testicular cancer.

Figure 1

CT scan demonstrating retro-peritoneal tumour. Abdominal CT scan from Case 3 highlighting retroperitoneal mass on ipsilateral side to original primary tumour. RPLND yielded a 120x85x40mm mass which was histologically confirmed as metastatic Leydig cell tumour.

Figure 2

Histopathology slides of primary and metastatic Leydig cell tumour. Sample obtained from Case 2. (A) Haematoxylin and Eosin (H&E) image demonstrating tumour in orchidectomy specimen (×1.25 magnification). (B) H&E image demonstrating severe cytological atypia in testicular primary (×20 magnification. (C) H&E image demonstrating tumour in mass from RPLND (×200 magnification). (D) Immunohistochemical staining of RPLND specimen demonstrating expression of Inhibin (×40 magnification). (E) H&E image demonstrating tumour RPLND specimen (×20 magnification).