Intracytoplasmic and intranuclear Reinke's crystals in a testicular Leydig‐cell tumor diagnosed by fine‐needle aspiration cytology: A case report with review of the literature

Abstract

We report on the cytopathologic findings of a Leydig-cell tumor of the testis in a young adult male with no evidence of endocrine dysfunction. The preoperative diagnosis was based on fine-needle aspiration cytology (FNAC) alone, which was subsequently confirmed on histopathology. The present case was of interest on account of the paucity of literature regarding the cytodiagnosis of this lesion. In addition, the finding of intracytoplasmic lipofuscin pigment and several intracytoplasmic as well as intranuclear Reinke's crystals served to clinch the diagnosis on FNA. Therefore, the use of FNAC, especially in the presence of diagnostic Reinke's crystals, may vitiate the need for more invasive biopsy procedures in the preoperative diagnosis of testicular Leydig-cell tumors.

Visualization of Reinke’s crystals in normal and cryptorchid testis

“…Since Reinke's crystals are important feature for the diagnosis of Leydig cell tumours (Gupta et al 1994;Hribar et al 2005;Jain et al 2001;Paraskevas and Scully 1989;Perez et al 1999), in the current work we wanted to improve the identification of Reinke's crystal in routine paraffin sections. A modified Masson's method turned out to yield the best results.…”

“…Reinke's crystals could be very helpful in the diagnosis of Leydig cell tumours since the presence of crystals is pathognomonic for the identification of such neoplasms (Assi et al 1997;Gupta et al 1994;Jain et al 2001;Marino et al 2003;Perez et al 1999). Unfortunately, they are present in only 20-30% of Leydig cells tumours (AlAgha and Axiotis 2007; Vielh et al 1991).…”

Testicular leydig cell tumor diagnosed on fine needle aspiration

“…Many studies have described the presence of Reinke's crystalloids in the cytoplasm and the nucleus as the pathognomonic feature for the diagnosis of LCT. [5][6][7] The crystals are pale-staining, refractile, cylindrical, rectangular or rhomboid structures (or inclusions) arranged in a linear fashion. However, their significance remains obscure.…”

“…While the histomorphology of this tumor is well described, only a few case reports are available in the literature on the cytological findings. [5][6][7] We report a case of LCT where the cytomorphologic features are highlighted.…”

Congenital adrenal hyperplasia: transitional care

“…Such lesions in CAH can present even before puberty [41]. Distinguishing between these tumours and a Leydig cell tumour can be difficult, but the adrenal rest tumours are usually bilateral, occur near the hilum of the testis and do not contain the Reinke crystals characteristic of Leydig cell tumours [42].…”