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Leydig Cell Tumors Treatment & Management

  • Author: Edmund S Sabanegh, Jr, MD; Chief Editor: Edward David Kim, MD, FACS  more...
 
Updated: Apr 17, 2015
 

Medical Care

Medical therapy plays little role in the management of Leydig cell tumor, as follows:

  • 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, [8] but this was not demonstrated in human trials [9]
  • No known role exists for radiation therapy in malignant Leydig cell tumors
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Surgical Care

Leydig cell tumors have been primarily managed with surgical extirpation using radical inguinal orchiectomy. Inguinal orchiectomy should be performed with early control of the spermatic cord and without violation of the scrotal skin.

However, testis-sparing surgery with enucleation of the mass, to maintain fertility, has been increasingly reported in children and younger adults .[4] 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. Frozen section examination successfully discriminated between benign and malignant neoplastic lesions in a study of 86 patients with testicular nodules, including five patients with Leydig cell tumors and six patients with Leydig cell hyperplasia.[10]

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.

In a retrospective study of 25 patients with testicular tumors who underwent testis-sparing surgery, including four patients with Leydig tumors, overall survival was 100% at a mean follow-up of 42.7 months. Three patients experienced local recurrence. Frozen-section examinations were performed in tumors from 14 patients; results matched the final pathological analysis in 11. None of the patient with a preserved testicle needed androgen therapy.[11]

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Contributor Information and Disclosures
Author

Edmund S Sabanegh, Jr, MD Chairman, Department of Urology, 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 of Andrology, Society of Reproductive Surgeons, Society for the Study of Male Reproduction, American Society for Reproductive Medicine, American Urological Association, SWOG

Disclosure: Nothing to disclose.

Coauthor(s)

Anil A Thomas, MD Urologist, Department of Urology, Sunnybrook Medical Office,Kaiser Permanente

Anil A Thomas, MD is a member of the following medical societies: American Urological Association, Endourological Society, Society of Robotic Surgery

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Tennessee Medical Association, Sexual Medicine Society of North America, American Society for Reproductive Medicine, American Society of Andrology, American Urological Association

Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Repros.

Additional Contributors

Erik T Goluboff, MD Professor, Department of Urology, College of Physicians and Surgeons, Columbia University College of Physicians and Surgeons; 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, Society for Basic Urologic Research

Disclosure: Nothing to disclose.

Acknowledgements

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.

Dan Theodorescu, MD, PhD Paul A Bunn Professor of Cancer Research, Professor of Surgery and Pharmacology, Director, University of Colorado Comprehensive Cancer 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: Key Genomics Ownership interest Co-Founder-50% Stock Ownership; KromaTiD, Inc Stock Options Board membership

References
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