Leydig cell tumor in grey zone: A case report

Abstract

Introduction: Leydig cell tumor constitutes only about 1-3% of testicular neoplasms. There is apparently increased incidence in the last few years; one possible explanation for this phenomenon is the widespread use of ultrasound technology and the subsequent increased early detection of smaller lesions that have not been found in historical series.

Case presentation: We report a case of Leydig cell tumor of testis in a patient presenting with painless long standing slowly growing left scrotal mass who found to have intrapulmonary nodule and multiple enlarged retroperitoneal lymph nodes on staging work up. The mass was managed by radical orchiectomy. Pathological diagnosis was Leydig cell tumor.

Discussion: Orchiectomy is the accepted mode of treatment but follow-up every 3-6 months with physical examination, hormone assays, scrotal and abdominal ultrasonography, chest radiography, and CT scans is essential in such a case with a potential for malignant behavior.

Conclusion: Inguinal orchiectomy is the therapeutic decision of choice and long-term follow-up is necessary to exclude recurrence or metastasis. Cases which fall in the grey zone like ours need to be followed up carefully for metastasis instead of rushing into an early retroperitoneal lymph node dissection, with its potential risks and complications.

Keywords: Inguinal orchiectomy; Leydig cell tumor; Malignant behavior; RPLND; Testicular neoplasms.

Fig. 1

Pelvic MRI with contrast, coronal view showing ill-defined left side lesion distorting the left testis that showed intense heterogeneous enhancement measuring 8.5 × 6 × 4 cm and thickened left spermatic cord.

Fig. 2

Pelvic MRI with contrast, transverse view showing ill-defined left side lesion distorting the left testis that showed intense heterogeneous enhancement measuring 8.5 × 6 × 4 cm.

Fig. 3

Pelvic MRI with contrast, sagittal view showing ill-defined left side lesion distorting the left testis that showed intense heterogeneous enhancement measuring 8.5 × 6 × 4 cm.

Fig. 4

Computed tomography prior to orchiectomy showing a retroperitoneal lymph node (arrow) measuring about 1.2 cm in maximum short axis diameter.

Fig. 5

A well circumscribed, encapsulated mass measures 6.5 × 5.5 × 3 cm in size, the mass is easily separated from tunica vaginalis (arrow) (No infiltrative margins), step sectioning revealed homogenous yellowish cut surface. No necrosis identified.

Fig. 6

Microscopic description. Section from tumor shows diffuse infiltrataion by medium to large polygonal cells with abundant eosinophilic cytoplasm and distinct cell borders, round nuclei and prominent nucleoli along with rich vascular network and scant stroma. There is no evidence of necrosis, vascular invasion or increased mitotic activity.

Fig. 7

Immunohistochemical stains. Calretinin, diffusely positive.

Fig. 8

Immunohistochemical stains. Inhibin, diffusely positive.

Fig. 9

Immunohistochemical stains. Melan A (MART-1), diffusely positive.

Fig. 10

Immunohistochemical stains. Vimentin, diffusely positive.

Fig. 11

Computed tomography 2 months post-orchiectomy showing the same retroperitoneal lymph node (arrow) measuring about 1.2 cm in maximum short axis diameter with no interval changes.