Leydig cell hyperplasia

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Leydig cell hyperplasia is an uncommon benign pathology of the testis.[1] It may be seen in the ovary.

Leydig cell hyperplasia
Diagnosis in short

Leydig cell hyperplasia. H&E stain. (WC)

LM abundant Leydig cells interspersed between seminiferous tubules with only Sertoli cells, Leydig cells do not displace or compress the seminiferous tubules
LM DDx Leydig cell tumour, testicular adrenal rest tumour
Site testis, ovary

Prevalence rare
Radiology hypoechoic lesions on ultrasound, often multiple
Prognosis benign

General

  • Benign.
  • Uncommonly seen in isolation by pathology.

A longer list of causes:[2]

  • Congenital (primary).
  • Secondary causes:
    • Germ cell loss/decrease:
    • Endocrine-related:
      • Adrenal hyperplasia.
      • Excess hCG - exogenous or tumour.

Other associations:[2]

Gross

Features:

  • Unremarkable gross appearance of parenchyma. (???)
  • Normal or small testis. (???)

Note:

  • Hypoechoic lesions on ultrasound - often multiple, small.[3]

Microscopic

Features:

  • Abundant Leydig cells interspersed between seminiferous tubules with only Sertoli cells.
    • Leydig cells do not displace or compress the seminiferous tubules.

Note:

  • May form nodules up to 6 mm.[1]

DDx:

Images

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Testicle and Cord, Right, Orchitectomy:
- Leydig cell hyperplasia.
- Atrophic testis.
- NEGATIVE for germ cell neoplasia in situ (intratubular germ cell neoplasia).
- NEGATIVE for malignancy.

Comment:
Immunostains confirm the morphologic impression.

The Leydig cells are POSITIVE for inhibin, calretinin and melan A. The section is
NEGATIVE for PLAP and has a benign pattern for D2-40.

See also

References

  1. 1.0 1.1 Carucci, LR.; Tirkes, AT.; Pretorius, ES.; Genega, EM.; Weinstein, SP. (Feb 2003). "Testicular Leydig's cell hyperplasia: MR imaging and sonographic findings.". AJR Am J Roentgenol 180 (2): 501-3. doi:10.2214/ajr.180.2.1800501. PMID 12540460.
  2. 2.0 2.1 Naughton, CK.; Nadler, RB.; Basler, JW.; Humphrey, PA. (Feb 1998). "Leydig cell hyperplasia.". Br J Urol 81 (2): 282-9. doi:10.1046/j.1464-410X.1998.00503.x. PMID 9488073.
  3. 3.0 3.1 Sterbis, J.; E-Nunu, T. (2015). "Leydig cell hyperplasia in the setting of Klinefelter syndrome.". BMJ Case Rep 2015. doi:10.1136/bcr-2015-209805. PMID 26209412.