From the Guidelines
Leydig cell tumors are rare testicular cancers that develop from the Leydig cells, which produce testosterone, and are typically benign, with about 90% of cases not spreading to other parts of the body. These tumors can occur at any age, though they are most common in adults between 30-60 years old and in children between 5-10 years. The majority of Leydig cell tumors are benign, but they can cause hormonal imbalances due to the production of excess testosterone or other hormones. Symptoms may include early puberty in boys, breast development or reduced sex drive in men, and irregular menstruation in women if the tumor occurs in the ovary, although ovarian occurrence is extremely rare. Treatment typically involves surgical removal of the affected testicle, with regular follow-up monitoring, and for the small percentage of malignant tumors, additional treatments like chemotherapy may be necessary, as suggested for other types of sex cord-stromal tumors (SCSTs) such as Sertoli-Leydig cell tumors, where postoperative adjuvant chemotherapy should be considered for those patients with stage I poorly differentiated or with heterologous elements [level II–III] 1. Key points to consider in the management of Leydig cell tumors include:
- Early detection through regular testicular self-examinations
- Surgical removal of the affected testicle as the primary treatment
- Regular follow-up monitoring for benign cases
- Consideration of additional treatments like chemotherapy for malignant cases
- Awareness of the potential for hormonal imbalances and their symptoms.
From the Research
Definition and Characteristics of Leydig Cell Tumor
- Leydig cell tumor (LCT) is a rare tumor of the male testicular interstitium 2.
- LCTs are rare stromal tumors of the testis, not originating from germinal epithelium 3.
- These tumors are frequently hormonally active, leading to either feminizing or virilizing syndromes 2.
- The tumor is usually benign, but malignant variants can occur 2.
Diagnosis and Treatment
- The pathologic diagnosis of LCT is usually made based on morphologic characteristics of the tumor cells 2.
- The significance of Reinke crystals in the diagnosis of LCT both cytologically and histologically is underscored 2.
- While more than 90% of LCT are benign and treatment is only restricted to the testis, malignant subtypes require radical surgical resection of the testicular and metastatic sites 3.
- Testicle-sparing surgery has been shown to be a feasible and safe choice for patients with LCT, with a 100% disease-free survival rate in one study 4.
Prognosis and Follow-up
- Patients diagnosed with LCT have a good prognosis, with no local recurrence or metastasis observed in several studies 4, 5.
- Follow-up is crucial, with physical examination, tumor marker assays, scrotal and abdominal ultrasonography, chest radiography, and computed tomography (CT) scans recommended every 3 to 6 months 4.
- Gynaecomastia and low testosterone levels may persist despite surgical removal of the tumor 5.
Surgical Options
- Radical orchidectomy is still considered the gold standard for LCTs, but testis-sparing surgery (TSS) in conjunction with intraoperative frozen section (FSE) has been recently attempted with promising results 6.
- TSS has been shown to be a safe and effective option for selected patients, with no metastatic recurrence observed in one systematic review 6.