Malignant leydig cell tumor in a 91-year-old man: Case report

ABSTRACT Testicle tumors are a rare entity among men population, accounting for only 1-1.5% of all cancers among men. The stromal tumors of the sexual cord correspond just 4% of all testicular cancers. Only 10% of them are malignant. The major representative of the sex cord-stromal tumors is the Leydig cell tumor, corresponding to 75 to 80% of the total. It has bimodal age incidence, involving children and adults between 30 and 60 years. We report the caso of a 91-year-old man with malignant Leydig cell tumor, presenting increase of the volume of scrotum, local pain and hyperemia. The are few cases in the literature, only 1 with pacient above 85 years old.

The value of testicular ultrasound in the prediction of the type and size of testicular tumors

ABSTRACTObjectives:Ultrasound (US) is often used for the work-up of testicular pathology. The findings may implicate on its management. However, there is only scant data on the correlation between US findings and testicular tumor type and size. Herein, we report on a multicenter study, analyzing these correlations.Methods:The study included patients who underwent orchiectomy between 2000 and 2010. Their charts were reviewed for US echogeneity, lesion size, pathological dimensions, histology, and the presence of calcifications, fibrosis, necrosis and/or intraepithelial neoplasia. The incidence of these parameters in benign versus malignant lesions and seminomatous germ cell tumors (SGCT) versus nonseminomatous germ cell tumors (NSGCT) was statistically compared.Results:Eighty five patients fulfilled the inclusion criteria, 71 malignant (43 SGCT, 28 NSGCT) and 14 benign. Sonographic lesions were at least 20% smaller than the pathologically determined dimensions in 21 (25%) patients. The ability of US in estimating the size of malignant tumors was 71%, compared to 100% of benign tumors (p=0.03), with no significant difference between SGCT and NSGCT. Necrosis was more frequent in malignant tumors (p=0.03); hypoechogeneity and fibrosis were more frequent in SGCT than in NSGCT (p=0.002 and 0.04 respectively).Conclusions:Testis US of malignant lesions underestimates the size in 25% of the cases, a fact that may impact on the decision of testicular sparing surgery. The ultrasonic lesions were eventually proven to be benign in 16% of the cases. Therefore it is advised to apply frozen sections in borderline cases. Hypoechogeneity is more frequent in SGCT than NSGCT.

Tumores testiculares bilaterais por hiperplasia congênita de restos adrenais / Bilateral testicular tumors caused by congenital adrenal rest hyperplasia

OBJETIVOS: Tumores testiculares são uma rara condição associada à hiperplasia adrenal congênita (HAC) que decorrem da hiperplasia de restos adrenais intratesticulares (HRA), raramente ocorrendo associados a neoplasias malignas. Sua diferenciação histológica com tumores de células de Leydig é muito difícil, podendo levar a orquiectomias desnecessárias. O objetivo deste relato foi apresentar esse dilema diagnóstico em um paciente com HAC e tumores testiculares bilaterais. MÉTODOS: Relatou-se o caso de um paciente masculino, 16 anos, com diagnóstico de HAC desde os 3 anos de idade, que apresentava tumorações testiculares endurecidas, indolores e de crescimento lento, sendo encaminhado para orquiectomia bilateral. RESULTADOS: Foi decidido por tratamento conservador com prednisona, havendo significativa diminuição do volume testicular e normalização dos níveis de andrógenos. CONCLUSÃO: Este caso demonstra a importância de sempre se considerar a hipótese de HRA intratesticulares no diagnóstico diferencial dos tumores testiculares. A investigação e a conduta devem ser conduzidas de maneira cautelosa para se evitar orquiectomias desnecessárias.

OBJECTIVES: Testicular tumors are a rare condition associated with congenital adrenal hyperplasia (CAH), originated from intratesticular adrenal rest tumors, and they are rarely associated with malignant tumors. Their histological differentiation from Leydig-cell tumors is quite difficult, which would lead to inappropriate orchiectomies. Thus the objective of this report was to present this diagnostic dilemma. METHODS: Reported the case of 16-yr-old boy with previous diagnosis of CAH with bilateral testicular enlargement who was recommended to be submitted to a bilateral orchiectomy. RESULTS: Considering this findings, it was decided to treat conventionally with prednisone with significant reduction of testicular volume, and normalization of androgens levels. CONCLUSION: This case shows the importance of intratesticular adrenal rest tumors in the differential diagnosis of testicular tumors. Cautious approach during investigation and treatment are recommended to avoid inappropriate orchiectomies.

Fine needle aspiration of metastatic malignant Leydig cell tumor of testis: a case report.

A 53-year-old male presented with a right inguinal mass of one-year duration. The fine needle aspiration of the inguinal mass showed a highly cellular tumor composed of sheets and isolated, large round to polygonal cells with moderate pleomorphism. Many bare nuclei were seen with occasional intranuclear inclusions. A provisional diagnosis of metastasis probably of testicular tumour was made. The orchidectomy showed a brown tumor replacing the entire testis and infiltrating the epididymis. The histological features showed Leydig cell tumor without Reinke crystalloids.

Tumor de células de Leydig / Leydig cell tumor: case report

Se presenta un caso de tumor de células de Leydig, hallazgo no frecuente entre los tumores del testículo destacando aspectos clínicos, histopatológicos criterios diagnósticos y de tratamiento

Tumor de células de Leydig: hallazgo postginecomastia y asociado con quiste epididimario / Leydig cell tumor: postgynecomastia finding and associated with epididymal cyst

Se presenta un caso de leydigioma iagnosticado luego de cirugía por ginecomastia bilateral sucesiva asociado con quiste epididimario durante el seguimiento de tumor renal de células claras (incidentaloma) nefrectomizado 3 años antes

Tumor de células de Leydig: relato de três casos / Leydig cell tumor: report of three cases

Tumores de células de Leydig são as neoplassiass mais comuns do estroma gonadal. Eles representam 3 porcento dos tumores testiculares, porém apenas 10 porcento dos casos apresentam comportamento maligno. Os autores reportam 3 casos de tumores de células de Leydig do testículo observados no período de 6 anos. Todos os pacientes foram submetidos a orquiectomia radical por incisão inguinal. Os pacientes tiveram seguimento entre 5 meses e 5 anos; nenhum deles foi ao óbito pela doença ou mostrou sinais de recidiva tumoral

Tumor de celulas de Leydig del adulto / Adult Leydig-cell tumor

Presentamos un nuevo caso de un tumor de células de Leydig del adulto, tratado en el servicio de urología de Antártida Hospital Privado en el año 1996, su diagnóstico y seguimiento. Es preciso destacar la baja incidencia de esta patología dentro de los tumores testiculares (1-3 por ciento). Algunos de los parámetros humorales e histológicos pueden hacer sospechar un comportamiento agresivo. Un 10 por ciento de ellos evoluciona dfando metástasi a distancia. La ginecomastia se suele observar en un 30 por ciento de los adultos. El tratamiento es la orquifuniculectomía, siendo resistentes a la radioterapia y muy poco sensibles a la quimioterapia

Criança com pseudopuberdade precoce causada por tumor de células de Leydig / Precocious pseudopuberty in a child due to Leydig cell tumor

The authors report an unusual case of Leydig cell tumor in a 3 year-old child with a clinical picture of aggressive behavior and increase in the penile size since the age of 15 months. Genital examination showed a small increase in the consistency of the right testis and ultrasound showed a heterogeneous texture and increase in dimensions in relation to the left testis. Hormonal dosages showed increased serum testosterone with normal LH and FSH. All other hormonal tests were normal and adrenal and cranial tomographies did not reveal abnormalities. Anatomo-pathological examination of the right testis, removed by an inguinal incision showed the presence of a Leydig cell tumor. After surgery, normalization of testosterone levels was observed and identified in the early postoperative period. The authors present a discussion regarding this uncommon neoplasm

Tumor gigante de células de Sertoli-Leydig: presentación de un caso / A giant Sertoli-Leydig cell tumor: a case report

Se hace una revisión de la literatura referente al tumor de células de Sertoli-Leydig en el ovario, en aspectos anatómicos, histopatológicos, clínicos y terapéuticos. Se presenta el caso de un tumor gigante de este tipo, de comportamiento maligno, enfatizandose la rareza del mismo