Leydig cell tumour - Genitourinary oncology

Leydig cell tumour

Definition

This is a non-germ cell tumour of the stroma of the testis, derived from the Leydig cells.

Incidence/prevalence

Less common than germ-cell tumours.

Age

Two peaks 5–10 years and 30–35 years.

Sex

Male only

Aetiology

As for all testicular tumours.

Pathophysiology

Leydig cells are cells contained in the interstitium which normally produce testosterone. Leydig cell tumours may produce levels of steroid hormones (e.g. testosterone, oestrogens, corticosteroids) sufficient to cause systemic effects. Approximately 15% of adult tumours are malignant (in children they are invariably benign).

Clinical features

Local features as for testicular tumours, but they more commonly present with secondary effects such as gynaecomastia and loss of libido in adults. In prepubertal cases, precocious puberty and gynaecomastia may occur.

Macroscopy/microscopy

Circumscribed, yellow-brown, uniform tumour which ranges from 1 cm to a bulky mass. Microscopically, the cells resemble normal Leydig cells – sheets or nests of large, polygonal cells with round nuclei and abundant granular eosinophilic cytoplasm. Vacuolated cytoplasm, or pinkish crystals of Reinke may be seen.

Complications, investigations, treatment

As for testicular tumours.