eMedicine Specialties > Urology > Cancer, Testicle

Leydig Cell Tumors: Treatment & Medication

Author: Edmund S Sabanegh Jr, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Coauthor(s): Anil A Thomas, MD, Urology Resident, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation; Scott Rutchik, MD, Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine
Contributor Information and Disclosures

Updated: Jun 11, 2008

Treatment

Medical Care

  • Chemotherapy with the bleomycin-etoposide-platinum regimen used for germ cell malignancies has limited efficacy in managing malignant Leydig cell tumors.
  • The tyrosine kinase inhibitor imatinib has shown some chemotherapeutic activity in animal models,4 although this was not demonstrated in human trials.5
  • No known role exists for radiation therapy in malignant Leydig cell tumors.

Surgical Care

  • Leydig cell tumors have been primarily managed with surgical extirpation using radical inguinal orchiectomy. However, increasing reports have described conservative management with testis-sparing surgery in younger adults and children.
  • Inguinal orchiectomy should be performed with early control of the spermatic cord and without violation of the scrotal skin.
  • Testis-sparing surgery with enucleation of the mass has been reported in children and younger adults in order to maintain fertility.1 Typically, this testis-sparing approach is performed through an inguinal or scrotal incision, and intraoperative ultrasound guidance has been used to locate nonpalpable tumors. The mass is enucleated with a small surrounding edge of testicular parenchyma and immediately sent for frozen section analysis. Additional frozen sections of the tumor bed can be assessed and/or a radical inguinal orchiectomy can be performed if malignancy is subsequently suspected.
  • If the tumor appears malignant, a retroperitoneal lymph node dissection is also recommended.

More on Leydig Cell Tumors

Overview: Leydig Cell Tumors
Differential Diagnoses & Workup: Leydig Cell Tumors
Treatment & Medication: Leydig Cell Tumors
Follow-up: Leydig Cell Tumors
Multimedia: Leydig Cell Tumors
References
[ CLOSE WINDOW ]

References

  1. Henderson CG, Ahmed AA, Sesterhenn I, Belman AB, Rushton HG. Enucleation for prepubertal leydig cell tumor. J Urol. Aug 2006;176(2):703-5. [Medline].

  2. Iczkowski KA, Bostwick DG, Roche PC, Cheville JC. Inhibin A is a sensitive and specific marker for testicular sex cord-stromal tumors. Mod Pathol. Aug 1998;11(8):774-9. [Medline].

  3. Augusto D, Leteurtre E, De La Taille A, Gosselin B, Leroy X. Calretinin: a valuable marker of normal and neoplastic Leydig cells of the testis. Appl Immunohistochem Mol Morphol. Jun 2002;10(2):159-62. [Medline].

  4. Basciani S, Brama M, Mariani S, De Luca G, Arizzi M, Vesci L, et al. Imatinib mesylate inhibits Leydig cell tumor growth: evidence for in vitro and in vivo activity. Cancer Res. Mar 1 2005;65(5):1897-903. [Medline].

  5. Froehner M, Beuthien-Baumann B, Dittert DD, Schuler U, Wirth MP. Lack of efficacy of imatinib in a patient with metastatic Leydig cell tumor. Cancer Chemother Pharmacol. Nov 2006;58(5):716-8. [Medline].

  6. Al-Agha OM, Axiotis CA. An in-depth look at Leydig cell tumor of the testis. Arch Pathol Lab Med. Feb 2007;131(2):311-7. [Medline].

  7. Bertram KA, Bratloff B, Hodges GF, Davidson H. Treatment of malignant Leydig cell tumor. Cancer. Nov 15 1991;68(10):2324-9. [Medline].

  8. Brunner HG, Otten BJ. Precocious puberty in boys. N Engl J Med. Dec 2 1999;341(23):1763-5. [Medline].

  9. Carmignani L, Colombo R, Gadda F, Galasso G, Lania A, Palou J, et al. Conservative surgical therapy for leydig cell tumor. J Urol. Aug 2007;178(2):507-11; discussion 511. [Medline].

  10. Cheville JC. Classification and pathology of testicular germ cell and sex cord-stromal tumors. Urol Clin North Am. Aug 1999;26(3):595-609. [Medline].

  11. Dilworth JP, Farrow GM, Oesterling JE. Non-germ cell tumors of testis. Urology. May 1991;37(5):399-417. [Medline].

  12. Grem JL, Robins HI, Wilson KS, Gilchrist K, Trump DL. Metastatic Leydig cell tumor of the testis. Report of three cases and review of the literature. Cancer. Nov 1 1986;58(9):2116-9. [Medline].

  13. Holm M, Rajpert-De Meyts E, Andersson AM, Skakkebaek NE. Leydig cell micronodules are a common finding in testicular biopsies from men with impaired spermatogenesis and are associated with decreased testosterone/LH ratio. J Pathol. Mar 2003;199(3):378-86. [Medline].

  14. Kaufman E, Akiya F, Foucar E, Grambort F, Cartwright KC. Viralization due to Leydig cell tumor diagnosis by magnetic resonance imaging. Case management report. Clin Pediatr (Phila). Jul 1990;29(7):414-7. [Medline].

  15. Kim I, Young RH, Scully RE. Leydig cell tumors of the testis. A clinicopathological analysis of 40 cases and review of the literature. Am J Surg Pathol. Mar 1985;9(3):177-92. [Medline].

  16. Konrad D, Schoenle EJ. Ten-year follow-up in a boy with Leydig cell tumor after selective surgery. Horm Res. 1999;51(2):96-100. [Medline].

  17. Maeda T, Itoh N, Kobayashi K, et al. Elevated serum estradiol suggesting recurrence of Leydig cell tumor nine years after radical orchiectomy. Int J Urol. Nov 2002;9(11):659-61. [Medline].

  18. Mineur P, De Cooman S, Hustin J, Verhoeven G, De Hertogh R. Feminizing testicular Leydig cell tumor: hormonal profile before and after unilateral orchidectomy. J Clin Endocrinol Metab. Apr 1987;64(4):686-91. [Medline].

  19. Ober WB, Sciagura C. Leydig, Sertoli, and Reinke: three anatomists who were on the ball. Pathol Annu. 1981;16 Pt 1:1-13. [Medline].

  20. Testis-sparing surgery for benign testicular tumors in children. J Urol. Jun 2001;165(6 Pt 2):2280-3. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

Leydig cell tumor, stromal testis tumor, interstitial testis tumor, interstitial testicular tumor, precocious puberty, androgenizing tumors, feminizing syndrome, virilizing syndrome, testicular neoplasms

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Edmund S Sabanegh Jr, MD, Director, Center for Male Fertility, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Edmund S Sabanegh Jr, MD is a member of the following medical societies: American Medical Association, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, Society for the Study of Male Reproduction, Society of Reproductive Surgeons, and Southwest Oncology Group
Disclosure: Nothing to disclose.

Coauthor(s)

Anil A Thomas, MD, Urology Resident, Glickman Urological and Kidney Institute, Cleveland Clinic Foundation
Anil A Thomas, MD is a member of the following medical societies: American Urological Association and Endourological Society
Disclosure: Nothing to disclose.

Scott Rutchik, MD, Assistant Professor, Department of Surgery, Division of Urology, University of Connecticut School of Medicine
Scott Rutchik, MD is a member of the following medical societies: American Urological Association
Disclosure: Nothing to disclose.

Medical Editor

Erik T Goluboff, MD, Professor, Department of Urology, College of Physicians and Surgeons, Columbia University; Director of Urology, Allen Pavilion, New York Presbyterian Hospital
Erik T Goluboff, MD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, American Urological Association, Medical Society of the State of New York, New York Academy of Medicine, Phi Beta Kappa, and Society for Basic Urologic Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Dan Theodorescu, MD, PhD, Paul Mellon Professor of Urologic Oncology, Department of Urology, University of Virginia Health Sciences Center
Dan Theodorescu, MD, PhD is a member of the following medical societies: American Cancer Society, American College of Surgeons, American Urological Association, Medical Society of Virginia, Society for Basic Urologic Research, and Society of Urologic Oncology
Disclosure: Nothing to disclose.

CME Editor

J Stuart Wolf Jr, MD, FACS, David A Bloom Professor of Urology, Director of Division of Minimally Invasive Urology, Department of Urology, University of Michigan
J Stuart Wolf Jr, MD, FACS is a member of the following medical societies: American College of Surgeons, American Urological Association, Catholic Medical Association, Endourological Society, Society for Urology and Engineering, Society of Laparoendoscopic Surgeons, Society of University Urologists, and Society of Urologic Oncology
Disclosure: Terumo Corporation Consulting fee Consulting; Gyrus-ACMI Honoraria Speaking and teaching

Chief Editor

Edward David Kim, MD, FACS, Professor of Surgery, Division of Urology, University of Tennessee Graduate School of Medicine; Consulting Staff, University of Tennessee Medical Center
Edward David Kim, MD, FACS is a member of the following medical societies: American College of Surgeons, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association, and Tennessee Medical Association
Disclosure: Lilly Consulting fee Consulting; Astellas Consulting fee Speaking and teaching; Indevus Consulting fee Speaking and teaching

RELATED MEDSCAPE ARTICLES
Articles
 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.