Top

Published in:

01-11-2020 | Infertility | Original Article

Leydig-cell tumour of the testis: retrospective analysis of clinical and therapeutic features in 204 cases

Authors: Christian Guido Ruf, Nojan Sanatgar, Hendrik Isbarn, Birgit Ruf, Jörg Simon, Christian Daniel Fankhauser, Klaus-Peter Dieckmann

Published in: World Journal of Urology | Issue 11/2020

Abstract

Purpose

Leydig-cell tumours (LCT) of the testis are poorly understood clinically. The aim of this report is to analyse the clinical characteristics of LCT in a large patient sample and to compare these findings with corresponding data of germ-cell tumours (GCT).

Methods

In a sample of 208 patients treated during 1995–2017 in 33 institutions, the following characteristics were registered: age, presenting symptoms, primary tumour size, testis-sparing surgery (TSS) or orchiectomy, malignancy, laterality, medical history, and outcome. Data analysis included descriptive statistical methods and logistic regression analysis.

Results

The ratio LCT:GCT is 1:23 (4.4%). The findings are as follows: median age 41 years, undescended testis 8%, bilateral LCTs 3%, malignant LCT 2.5%, contralateral GCT 2.5%, incidental detection 28%, scrotal symptoms 43%, infertility 18%, elevated estradiol levels 29%. TSS was performed in 56% with no local relapse. Of the patients with malignant LCT, one was cured through surgery.

Conclusion

LCT is rare, with a relative frequency (relative to GCT) of 1:23. Malignancy is found in 2.5%. LCT and GCT share a number of clinical features, e.g. bilaterality, history of undescended testis, and presenting age. TSS is safe in benign LCT. Surgery is the treatment of choice in malignant LCT.

Available only for authorised users

Idrees MT, Ulbright TM, Oliva E, Young RH, Montironi R, Egevad L et al (2017) The World Health Organization 2016 classification of testicular non-germ cell tumours: a review and update from the International Society of Urological Pathology Testis Consultation Panel. Histopathology 70:513–521CrossRef

Kim I, Young RH, Scully RE (1985) Leydig cell tumors of the testis. A clinicopathological analysis of 40 cases and review of the literature. Am J Surg Pathol 9:177–192

Di Tonno F, Tavolini IM, Belmonte P, Bertoldin R, Cossaro E, Curti P et al (2009) Lessons from 52 patients with Leydig cell tumor of the testis: the GUONE (North-Eastern Uro-Oncological Group, Italy) experience. Urol Int 82:152–157CrossRef

Masur Y, Steffens J, Ziegler M, Remberger K (1996) Leydigzell-Tumoren des Hodens—klinische und morphologische Aspekte. Urologe A 35:468–471CrossRef

Calleja RK, Rice A, Bullock KN (1999) Unilateral Leydig cell tumour associated with a contralateral undescended testis. BJU Int 83:152CrossRef

Dieckmann KP, Loy V (1993) Metachronous germ-cell and Leydig cell tumors of the testis. Do testicular germ cell tumors and Leydig cell tumors share risk factors? Cancer 72:1305–1307

Cheville JC, Sebo TJ, Lager DJ, Bostwick DG, Farrow GM (1998) Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. Am J Surg Pathol 22:1361–1367CrossRef

Suardi N, Strada E, Colombo R, Freschi M, Salonia A, Lania C et al (2009) Leydig cell tumour of the testis: presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience. BJU Int 103:197–200CrossRef

Loeser A, Vergho DC, Katzenberger T, Brix D, Kocot A, Spahn M et al (2009) Testis-sparing surgery versus radical orchiectomy in patients with Leydig cell tumors. Urology 74:370–372CrossRef

10.

Leonhartsberger N, Pichler R, Stoehr B, Horninger W, Steiner H (2014) Organ-sparing surgery is the treatment of choice in benign testicular tumors. World J Urol 32:1087–1091CrossRef

11.

Nicolai N, Necchi A, Raggi D, Biasoni D, Catanzaro M, Piva L et al (2015) Clinical outcome in testicular sex cord stromal tumors: testis sparing vs radical orchiectomy and management of advanced disease. Urology 85:402–406CrossRefPubMedCentral

12.

Bozzini G, Picozzi S, Gadda F, Colombo R, Decobelli O, Palou J et al (2013) Long-term follow-up using testicle-sparing surgery for Leydig cell tumor. Clin Genitourin Cancer 11:321–324CrossRef

13.

Rothermundt C, Thurneysen C, Cathomas R, Müller B, Mingrone W, Hirschi-Blickenstorfer A et al (2018) Baseline characteristics and patterns of care in testicular cancer patients: first data from the Swiss Austrian German Testicular Cancer Cohort Study (SAG TCCS). Swiss Med Wkly 148:w14640

14.

Dieckmann KP, Richter-Simonsen H, Kulejewski M, Ikogho R, Zecha H, Anheuser P et al (2018) Testicular germ-cell tumours: a descriptive analysis of clinical characteristics at first presentation. Urol Int 100:409–419CrossRefPubMedCentral

15.

Ruf CG, Isbarn H, Wagner W, Fisch M, Matthies C, Dieckmann KP (2014) Changes in epidemiologic features of testicular germ cell cancer: age at diagnosis and relative frequency of seminoma are constantly and significantly increasing. Urol Oncol 32(33):e1–6

16.

Dieckmann KP, Hartmann JT, Classen J, Lüdde R, Diederichs M, Pichlmeier U (2008) Tallness is associated with risk of testicular cancer: evidence for the nutrition hypothesis. Br J Cancer 99:1517–1521CrossRefPubMedCentral

17.

Heer R, Jackson MJ, El-Sherif A, Thomas DJ (2010) Twenty-nine Leydig cell tumors: histological features, outcomes and implications for management. Int J Urol. 17:886–889CrossRef

18.

Dieckmann KP, Kulejewski M, Pichlmeier U, Loy V (2007) Diagnosis of contralateral testicular intraepithelial neoplasia (TIN) in patients with testicular germ cell cancer: systematic two-site biopsies are more sensitive than a single random biopsy. Eur Urol 51:175–185CrossRef

19.

Banks K, Tuazon E, Berhane K, Koh CJ, De Filippo RE, Chang A et al (2012) Cryptorchidism and testicular germ cell tumors: comprehensive meta-analysis reveals that association between these conditions diminished over time and is modified by clinical characteristics. Front Endocrinol (Lausanne). 3:182. https://doi.org/10.3389/fendo.2012.00182CrossRef

20.

Heidenreich A, Moul JW, Srivastava S, Engelmann UH (1997) Synchronous bilateral testicular tumour: nonseminomatous germ cell tumours and contralateral benign tumours. Scand J Urol Nephrol 31:389–392CrossRef

21.

Dieckmann KP, Becker T, Bauer HW (1987) Testicular tumors: presentation and role of diagnostic delay. Urol Int 42:241–247CrossRef

22.

Moul JW (2007) Timely diagnosis of testicular cancer. Urol Clin North Am. 34:109–117CrossRef

23.

Carmignani L, Salvioni R, Gadda F, Colecchia M, Gazzano G, Torelli T et al (2006) Long-term follow up and clinical characteristics of testicular Leydig cell tumor: experience with 24 cases. J Urol 176:2040–2403CrossRef

24.

Germa-Lluch JR, Garcia del Muro X, Maroto P, Paz-Ares L, Arranz JA, Guma J et al (2002) Clinical pattern and therapeutic results achieved in 1490 patients with germ-cell tumours of the testis: the experience of the Spanish germ-cell cancer group (GG). Eur Urol 42:553–563

25.

Andreassen KE, Grotmol T, Cvancarova MS, Johannesen TB, Fossa SD (2011) Risk of metachronous contralateral testicular germ cell tumors: a population-based study of 7102 Norwegian patients (1953–2007). Int J Cancer 129:2867–2874CrossRef

26.

Bandak M, Jørgensen N, Juul A, Lauritsen J, Gundgaard-Kier MG, Mortensen MS et al (2017) Preorchiectomy Leydig cell dysfunction in patients with testicular cancer. Clin Genitourin Cancer 15:e37–e43CrossRef

27.

Wegner HE, Dieckmann KP, Herbst H, Andresen R, Miller K (1997) Leydig cell tumor—comparison of results of radical and testis-sparing surgery in a single center. Urol Int 59:170–173CrossRef

28.

Nason GJ, Redmond EJ, Considine SW, Omer SI, Power D, Sweeney P (2017) The natural history of Leydig cell testicular tumours: an analysis of the National Cancer Registry. Ir J Med Sci 187:323–326CrossRef

29.

Al-Agha OM, Axiotis CA (2007) An in-depth look at Leydig cell tumor of the testis. Arch Pathol Lab Med 131:311–317

30.

Farkas LM, Székely JG, Pusztai C, Baki M (2000) High frequency of metastatic Leydig cell testicular tumours. Oncology 59:118–121CrossRef

31.

Bokemeyer C, Harstrick A, Gonnermann O, Schöber C, Kuczyk M, Poliwoda H et al (1993) Metastatic Leydig cell tumours of the testis: report of four cases and review of the literature. Int J Oncol 2:241–244

Title: Leydig-cell tumour of the testis: retrospective analysis of clinical and therapeutic features in 204 cases
Authors: Christian Guido Ruf
Nojan Sanatgar
Hendrik Isbarn
Birgit Ruf
Jörg Simon
Christian Daniel Fankhauser
Klaus-Peter Dieckmann
Publication date: 01-11-2020
Publisher: Springer Berlin Heidelberg
Keywords: Infertility
Infertility
Undescended Testis
Published in: World Journal of Urology / Issue 11/2020
Print ISSN: 0724-4983
Electronic ISSN: 1433-8726
DOI: https://doi.org/10.1007/s00345-020-03079-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Leydig-cell tumour of the testis: retrospective analysis of clinical and therapeutic features in 204 cases

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 11/2020

Five compelling UTI questions after kidney transplant

Substantial radiation dose reduction with consistent image quality using a novel low-dose stone composition protocol

Urological infections in the developing world: an increasing problem in developed countries

Inflammation is a target of medical treatment for lower urinary tract symptoms associated with benign prostatic hyperplasia

Recurrent bladder cystitis: who takes the role?

Traumatic spinal cord injury confers bladder cancer risk to patients managed without permanent urinary catheterization: lessons from a comparison of clinical data with the national database