Increased incidence of Leydig cell tumours of the testis in the era of improved imaging techniques

Abstract

Study Type – Diagnostic (exploratory cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Leydig cell tumours (LCTs) of the testis are rare tumours, accounting for 1–3% of all testicular neoplasms. Our data indicate that using scrotal ultrasound with high resolution imaging in routine checkups leads to an earlier detection of LCTs. Most patients underwent an organ‐sparing surgery and no androgen deprivation was observed. OBJECTIVE • To report an observed high frequency of Leydig cell tumours (LCTs) diagnosed at our centre. PATIENTS AND METHODS • Charts of all patients who underwent surgery for a testicular tumour between 1999 and 2008 at our department were searched and data from patients with LCT were collected. • Before surgery all patients underwent ultrasound and complete staging. In all but two patients with LCT an organ‐sparing surgery was performed. Surgery was performed under ultrasound or palpation guidance. • All patients underwent postoperative follow‐up. We retrospectively reviewed surgical technique, histology, epidemiology and outcome in all LCT patients. RESULTS • In the study period, 197 testicular tumours were surgically removed of which 29 were diagnosed as LCT (14.7% of 197; further study group) in 25 patients. Mean age of patients with LCT was 45 years (range 21–68 years). • Tumour size ranged from 1.2 to 80 mm (mean 10.23 mm). In two patients (8%) the lesion was palpable whereas incidental diagnosis was made in seven patients (28%). • In the remaining patients diagnosis was made by ultrasound performed for testicular pain (six patients, 24%) or during infertility or erectile dysfunction evaluation (10 patients, 40%). • Definitive histology reported no malignant histopathological features in all but one patient; this particular patient experienced tumour progression after 2 months and died from advanced disease 1 year later. All other patients are free of disease after a mean follow up of 56 months (range 7–93 months). • During this period one patient developed a second LCT on the contralateral side; another patient had a recurrence within the same testicle, but on the opposite pole. Both underwent a subsequent organ‐sparing tumour resection. CONCLUSION • The percentage of LCT (14.7% of all testicular tumours removed) was significantly higher than expected from the literature. One possible explanation for this phenomenon is the increasing use of better ultrasound technology and the subsequent increased detection of small nodules that have not been found in historical series. Use of ‘observation‐only’ for very small lesions detected at infertility clinics is under debate.

One lump or two? Concomitant Leydig cell tumour and paratesticular leiomyoma in an adult man

“…MRI can detect small non-palpable LCTs otherwise not visible on ultrasonography 10. On ultrasonography, LCTs usually appear as a non-homogeneous hypoechoic testicular nodule with peripheral hypervascularity and minimal internal colour Doppler flow 11.…”

Testicular Tumor Ultrasound Characteristics and Association with Histopathology

“…Leydig cell tumors are being discovered more frequently as testicular ultrasound is performed for indications other than palpable testicular mass [21]. Leydig cell tumors often demonstrate homogeneous hypoechoic echo texture similar to that of seminoma; smaller size (usually <1 cm) and a characteristic ‘halo’ of Doppler vascular flow surrounding the periphery of the tumor are clues to their identification [22].…”

A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

“…1 The majority of these tumours occur between the ages of 20-60 years and most commonly present with painless testicular enlargement or a palpable mass. 2 Though uncommon, patients can present symptomatically. Symptoms from excessive hormone secretion, such as gynecomastia, can be seen in up to 15% of adults with Leydig cell tumours, though Sertoli cell tumours are rarely symptomatic.…”

“…1,9 Other studies have reported higher rates of metastatic disease, with Bertram et al reporting a 20% rate of metastatic disease at the time of diagnosis and a 40% risk of metastatic involvement within two years of diagnosis. 10 Furthermore, malignant SCSTs have been reported to respond poorly to conventional radiotherapy and cytotoxic Lindsay M. Yuh, MD 1,5 ; Primo N. Lara Jr, MD 2,5 ; Rebecca M. Wagenaar, MD 1,5 ; Christopher P. Evans, MD 1,5 ; Marc A. Dall'era, MD 1,5 ; Rosemary Cress, MD 3,4,5 ; Stanley A. Yap, MD A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome scsT: Detection and intervention chemotherapy. Controversy remains as to the recommended treatment due to a lack of evidence-based data.…”