Incidental bilateral leydig cell tumor of the testes

Testis tumors are extremely rare tumors, especially if they are bilateral, interstitial tumors. We present a case with bilateral Leydig cell tumors, which were detected incidentally. First, radical left orchiectomy was performed and pathologic diagnosis was Leydig cell tumor. One week later, partial right orchiectomy was done. The diagnosis was the same. After the 12-month follow-up, no recurrence or metastasis was detected. We suggest organ-sparing surgery as an alternative in the treatment of bilateral Leydig cell tumors especially for young males, since this surgical approach prevents hormonal replacement therapy and maintains fertility and potency.     

双侧睾丸间质细胞瘤1例报告并文献复习

目的 探讨睾丸间质细胞瘤的诊断和治疗经验.方法 报告1例双侧睾丸间质细胞瘤患者的临床资料并文献复习.结果 根据患者临床表现及相关检查,术前诊断考虑为双侧睾丸间质细胞瘤,术中快速冰冻病理检查示双侧睾丸间质细胞瘤,行睾丸肿瘤剜除术.术后随访6个月未见肿瘤复发或转移.结论 睾丸间质细胞瘤是一种较为罕见的睾丸肿瘤.术前诊断较为困难,睾酮、雌二醇等性激素水平升高及男性乳房发育等症状对睾丸间质细胞瘤的诊断有重要意义,确诊仍需依赖病理组织学检查.传统的手术方法采用根治性睾丸切除术,然而对于青春期前患者、双侧睾丸间质细胞瘤等患者,可以施行保留睾丸的肿瘤剜除术.     

Organ-sparing surgery for bilateral leydig cell tumor of the testis

Leydig cell tumors of the testis are uncommon, and bilateral lesions are extremely rare. We report a case of bilateral Leydig cell tumor of the testis treated with radical orchiectomy and contralateral subtotal orchiectomy with the intent of preservation of hormonal function and fertility.     

Adrenal adenoma with bilateral testicular Leydig cell tumor: a case report

A case of left adrenal adenoma with bilateral testicular Leydig cell tumor in a 38-year-old man is reported. He had received bilateral orchiectomy for testicular Leydig cell tumor at the age of 37. After operation computed tomography revealed left adrenal mass and aldosterone-secreting adrenal tumor was suspected. Left adrenalectomy was performed and histopathological diagnosis was adrenocortical adenoma. Serum ACTH, aldosterone and plasma renin activity were still high after operation. The adrenal cortex and gonads are of common embryologic origin and the histologic pattern may overlap. Examination of the adrenal gland is necessary for the patient with a testicular Leydig cell tumor.     

Elevated serum estradiol suggesting recurrence of Leydig cell tumor nine years after radical orchiectomy

We report a case of a Leydig cell tumor that showed retroperitoneal lymph node metastasis 9 years after radical orchiectomy. Elevated serum estradiol (E2) suggested recurrence of the Leydig cell tumor. Retroperitoneal lymph node dissection (RPLND) was performed and the lymph node was proved histopathologically to have a metastatic Leydig cell tumor. After RPLND, serum E2 returned to the normal range. This is the first reported case in which changes in the endocrinological findings were useful as likely tumor markers to detect the recurrence of a Leydig cell tumor.     

Morphological and Endocrinological Differences between the Abdominal Testes in Bilateral and Unilateral Cryptorchid Rats

Using a new experimental model of cryptorchism in rats, where testicular descent was prevented, testicular development and function were studied in bilateral and unilateral cryptorchid animals Morphometric and radioimmunological techniques were used. Up to 30 days after birth testicular development was identical in the two types of abdominal testes but in adult rats differences were observed. In these rats spermatogenesis was damaged to a similar extent, but total tubular length and testicular weight were increased in the bilateral abdominal testes. Moreover, in these testes, the volume density of Leydig cells, the total Leydig cell mass, the average Leydig cell size and the testis testosterone concentration were larger than in unilateral abdominal testes. It is suggested that the impaired spermatogenesis seen in both kinds of abdominal testes may be unrelated to Leydig cell function.     

Ultrasound detection of bilateral Leydig cell tumors in palpable normal testes

We report a case of synchronous, nonpalpable, bilateral Leydig cell tumors that were detected only by ultrasound evaluation and gonadal vein sampling for estradiol. A review of the diagnostic and management options for Leydig cell tumors is presented.     

Effect of cryptorchidism on the morphology of testicular macrophages: Evidence for a Leydig cell-macrophage interaction in the rat testis

Macrophages and Leydig cells in the testes of adult rats which had been made bilaterally or unilaterally cryptorchid at birth were examined by morphometry for total mass, total number, volume density, and individual cell profile area. The total Leydig cell mass and the average size of Leydig cells, as well as the total mass and the average size of macrophages, were reduced in unilateral abdominal testes, but were unchanged in bilateral abdominal testes when compared to scrotal testes. Leydig cell and macrophage morphology were correlated suggesting a functional coupling between these cell types. The physiological significance of this cell interaction remains to be discovered.     

Bilateral Leydig cell tumors and male infertility: case report

A 38-year-old man with a complaint of male infertility due to azoospermia was found to have bilateral Leydig cell tumors. The tumors were synchronous, not clearly palpable and not diagnostic by ultrasonography. The serum level of estradiol was remarkably increased, and that of testosterone was above the normal upper limit. Tumors of 0.8 cm in diameter were detected by scrotal exploration, and findings of Leydig cell tumors in the bilateral testes were confirmed by histologic and electron-microscopic studies.     

Synchronous bilateral primary germ cell tumors in patient receiving estrogen therapy

The present report concerns the occurrence of bilateral synchronous germ cell tumors in a sixty-eight-year-old man who received estrogen therapy for eleven months. Although there are previous reports on Leydig cell tumors developing in mice and man receiving estrogens, we have not found any connection between germ cell tumors and estrogen medication reported in the literature.     

Hyperplasia of adrenal rests in the testicle: a rare cause of male infertility

We report the case of a 37-year-old man with infertility caused by bilateral testicular masses secondary to congenital adrenal hyperplasia (21-hydroxylase deficiency). Testicular biopsy was done and its was initially interpreted as Leydig cell tumor but after clinical information was histologically reclassified as tumor of the adrenogenital syndrome. The differential diagnosis with Leydig cell tumor is discussed and it must be established through the clinical, biochemical, radiological and pathological features.     

Metachronous contralateral Leydig cell tumor of the testis: conservative treatment

Leydig cell tumors are the primary nongerm cell tumors of the testis, comprising approximately 1 to 3% of all testicular neoplasms. These tumors are bilateral in 5 to 10% of cases. Hypoechoic testicular nodule associated to a child virilising syndrome or adult gynecomastia with negative testis tumor markers (AFP, B-HCG) show a high index suspicion for this entity. We report a case of metachronous contralateral Leydig cell tumor in a 32 years old man with a 9 year interval between presentations, in which we performed local excision of the lesion. Diagnostic an therapeutic aspects are reviewed in literature. Since preoperative diagnosis of Leydig cell tumors in difficult and clinical course unpredictible, radical orchiectomy has been the standard treatment. Emphasis is made on conservative management opportunity in patients with only one testis, small tumors (less than 2.5 cm) with biopsies from tumor bed negative and wishes to remain fertile and/or refuses androgen supplementation. Follow-up is mandatory by performing scrotal ultrasounds. CT scan, Chest X-Ray, tumor markers and hormone determinations (testosterone, estradiol, progesterone, LH and FSH).     

Role of contrast-enhanced ultrasound with Sonazoid in management of small testicular Leydig cell tumours: A case report with literature review

Small testicular solid lesions are discovered accidentally due to the extensive use of ultrasound in urology and andrology. Early differentiation between benign and malignant testicular neoplasms is crucial for the determination of treatment options, especially for sub-centimetre lesions. We report a case of a male patient with an incidental discovery of a small testicular lesion on ultrasonography with the chief complaint of left testicular discomfort. The blood-flow distribution and microbubble dynamics in the lesion were evaluated through contrast-enhanced ultrasound using Sonazoid intravenous bolus injection, the rapid and intense enhancement pattern tended to be testicular Leydig cell tumour. Through testicular-sparing surgery, the lesion was excised, and benign testicular Leydig cell tumour was confirmed by post-operative pathology and immunohistochemical pathology. No sign of recurrence or metastasis was detected during follow-up.     

Postpubertal cryptorchism. Morphofunctional study with special reference to Leydig's cells

In a group of 17 patients of postpubertal age with unilateral (n = 15) or bilateral (n = 2) cryptorchism, a significant decrease in the tubular diameter was observed, in addition to Leydig cell hyperplasia (many with cytoplasm vacuolization and/or atrophy) in both the cryptorchid testes and in the contralateral scrotal testes. The number of testosterone-positive Leydig cells in testicular tissue sections, studied with peroxidase-antiperoxidase, was diminished in the cryptorchid testes, whereas in the contralateral scrotal testes it was similar to the control group. Together with normal testosterone levels and elevated luteinizing hormone and follicle-stimulating hormone levels in peripheral blood, this leads us to think of a compensated dysfunction of the Leydig cells. This possible lower testosterone production by the Leydig cells in the cryptorchid testis is not borne out morphologically, where the volume of the organelles is similar to the contralateral scrotal testes.     

Leydig cell tumor in grey zone: A case report

IntroductionLeydig 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 presentationWe 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.DiscussionOrchiectomy 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.ConclusionInguinal 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.     

Testicular seminoma presenting withfeatures of androgen excess

A 32-year-old white man presented with worsening acne and noticeable increase in muscle bulk. On examination, a firmer area with a granular consistency was noted in the right testis. A right radical orchiectomy was performed and the histologic findings were those of a typical seminoma associated with marked Leydig cell hyperplasia. A solitary right iliac lymph node metastasis, but not the primary seminoma, contained human chorionic gonadotrophin- (HCG) producing syncytiotrophoblast, which was regarded as the hormonal stimulus for Leydig cell hyperplasia and elevated serum testosterone. This seems to be the first report of testicular seminoma presenting with symptoms of androgen excess.     

双侧短期隐睾大鼠睾丸形态及抑制素的研究

本文研究了双侧短期人为隐睾大鼠睾丸的形态及抑制素的变化。结果发现隐睾一周和四周的大鼠睾丸和付睾重量均减轻。曲细精管直径缩小(平均直径:对照组250μm±43.75μm,1周组,159.5±32.25;4周组139.25±22.5;与对照组比P均<0.01)。Leydig细胞切面面积比明显增大(对照组为(％)6±2.4,1周组为21.83±7.4,4周组为23±11.38,P均<0.01)。电镜发现隐睾组leydig氏细胞线粒体和内浆网数量均增多,局部呈囊性扩张。睾丸间液和血清抑制素含量均明显下降(与对照组比P分別<0.01和<0.05),表明曲细精管破坏与leydig细胞呈一定的负相关。支持精管控制leydig氏细胞的理论,是否抑制素参于这一过程有待证实。     

Leydig cell tumor of intra-abdominal testis

A patient with bilateral cryptorchidism and gynecomastia due to Leydig cell tumor involving the left intra-abdominal testis is described. Raised serum estrogen, low serum testosterone, and ultrasonic demonstration of a tumor in the left testis allowed the diagnosis to be suspected preoperatively. The relevant literature is reviewed.     

Bilateral adrenal masses from renal cell carcinoma: a case report

We report a case of bilateral adrenal metastasis from renal cell carcinoma. A 65-year-old man was referred to our hospital for a right renal mass. A computed tomography revealed a 9 cm right renal tumor and bilateral adrenal masses (3.5 cm on the right side and 4.5 cm on the left). A right radical nephrectomy and bilateral adrenalectomy demonstrated renal cell carcinoma with metastasis to bilateral adrenal glands. The pathological findings of the right renal tumor showed clear cell carcinoma, G3 > G2 and both adrenal tumors showed the same pathology as the right renal tumor. The patient is alive with lung metastasis after 15 months postoperatively treated with interferon-alpha.     

Leydig cell tumor in two brothers with congenital adrenal hyperplasia due to 11-β hydroxylase deficiency: a case report

Congenital adrenal 11-β hydroxylase deficiency is a rare autosomal recessive syndrome characterized by deficient cortisol synthesis and testicular masses. It is extremely difficult to distinguish testicular tumors caused by this syndrome from Leydig cell tumors. As management for each differs, it is important to differentiate the syndromes from each other. Hereby, we present the case of two brothers affected by 11-β hydroxylase deficiency and presenting with bilateral testicular masses. Two differential diagnoses were noticed for both patients: testicular adrenal rest tumors (TART) and Leydig cell tumor (LCT). In this study the tumors were yellow, firm, and non-tender with intra-testicular location. Histological studies showed cells in a cluster arrangement with low lipochrome pigment concentration. Tumors were unresponsive to ACTH suppression therapy, but a drop in levels of plasma testosterone and urinary 17-ketosteroids occurred after surgical treatment. Considering all above, they were finally diagnosed as having Leydig cell tumors. Both cases were managed by testis-sparing surgery.