Leydig Cell Tumors Treatment & Management
- Author: Edmund S Sabanegh, Jr, MD; Chief Editor: Edward David Kim, MD, FACS more...
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
No known role exists for radiation therapy in malignant Leydig cell tumors
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 . 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.
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.
Leonhartsberger N, Ramoner R, Aigner F, Stoehr B, Pichler R, Zangerl F, et al. Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques. BJU Int. 2011 Nov. 108(10):1603-7. [Medline].
Lock G, Schmidt C, Helmich F, Stolle E, Dieckmann KP. Early experience with contrast-enhanced ultrasound in the diagnosis of testicular masses: a feasibility study. Urology. 2011 May. 77(5):1049-53. [Medline].
Bozzini G, Picozzi S, Gadda F, Colombo R, Decobelli O, Palou J, et al. Long-Term Follow-Up Using Testicle-Sparing Surgery for Leydig Cell Tumor. Clin Genitourin Cancer. 2013 Jan 10. [Medline].
Henderson CG, Ahmed AA, Sesterhenn I, Belman AB, Rushton HG. Enucleation for prepubertal leydig cell tumor. J Urol. 2006 Aug. 176(2):703-5. [Medline].
Stoop H, Kirkels W, Dohle GR, Gillis AJ, den Bakker MA, Biermann K, et al. Diagnosis of testicular carcinoma in situ '(intratubular and microinvasive)' seminoma and embryonal carcinoma using direct enzymatic alkaline phosphatase reactivity on frozen histological sections. Histopathology. 2011 Feb. 58(3):440-6. [Medline].
Iczkowski KA, Bostwick DG, Roche PC, Cheville JC. Inhibin A is a sensitive and specific marker for testicular sex cord-stromal tumors. Mod Pathol. 1998 Aug. 11(8):774-9. [Medline].
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. 2002 Jun. 10(2):159-62. [Medline].
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. 2005 Mar 1. 65(5):1897-903. [Medline].
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. 2006 Nov. 58(5):716-8. [Medline].
Bozzini G, Rubino B, Maruccia S, Marenghi C, Casellato S, Picozzi S, et al. Role of frozen section examination in the management of testicular nodules: a useful procedure to identify benign lesions. Urol J. 2014 Jul 8. 11(3):1687-91. [Medline].
Ferretti L, Sargos P, Gross-Goupil M, Izard V, Wallerand H, Huyghe E, et al. Testicular-sparing surgery for bilateral or monorchide testicular tumours: a multicenter study of long-term oncological and functional results. BJU Int. 2014 Dec. 114(6):860-4. [Medline].
Al-Agha OM, Axiotis CA. An in-depth look at Leydig cell tumor of the testis. Arch Pathol Lab Med. 2007 Feb. 131(2):311-7. [Medline].
Bertram KA, Bratloff B, Hodges GF, Davidson H. Treatment of malignant Leydig cell tumor. Cancer. 1991 Nov 15. 68(10):2324-9. [Medline].
Brunner HG, Otten BJ. Precocious puberty in boys. N Engl J Med. 1999 Dec 2. 341(23):1763-5. [Medline].
Carmignani L, Colombo R, Gadda F, Galasso G, Lania A, Palou J, et al. Conservative surgical therapy for leydig cell tumor. J Urol. 2007 Aug. 178(2):507-11; discussion 511. [Medline].
Cheville JC. Classification and pathology of testicular germ cell and sex cord-stromal tumors. Urol Clin North Am. 1999 Aug. 26(3):595-609. [Medline].
Dilworth JP, Farrow GM, Oesterling JE. Non-germ cell tumors of testis. Urology. 1991 May. 37(5):399-417. [Medline].
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. 1986 Nov 1. 58(9):2116-9. [Medline].
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. 2003 Mar. 199(3):378-86. [Medline].
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). 1990 Jul. 29(7):414-7. [Medline].
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. 1985 Mar. 9(3):177-92. [Medline].
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].
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. 2002 Nov. 9(11):659-61. [Medline].
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. 1987 Apr. 64(4):686-91. [Medline].
Ober WB, Sciagura C. Leydig, Sertoli, and Reinke: three anatomists who were on the ball. Pathol Annu. 1981. 16 Pt 1:1-13. [Medline].
Testis-sparing surgery for benign testicular tumors in children. J Urol. 2001 Jun. 165(6 Pt 2):2280-3. [Medline].