48,466
edits
Difference between revisions of "Leydig cell tumour"
Jump to navigation
Jump to search
→IHC
(→IHC) |
|||
| (16 intermediate revisions by the same user not shown) | |||
| Line 1: | Line 1: | ||
{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Leydig_cell_tumour3.jpg | | Image = Leydig_cell_tumour3.jpg | ||
| Width = | | Width = | ||
| Caption = Leydig cell tumour. [[H&E stain]]. | | Caption = Leydig cell tumour. [[H&E stain]]. | ||
| Synonyms = interstitial cell tumour | |||
| Micro = cytoplasmic vacuolization, cytoplasm -- clear to eosinophilic, +/-''Reinke crystals'' (cylindrical crystalloid -- eosinophilic cytoplasmic bodies), +/-[[nucleoli]] common, round nuclei | | Micro = cytoplasmic vacuolization, cytoplasm -- clear to eosinophilic, +/-''Reinke crystals'' (cylindrical crystalloid -- eosinophilic cytoplasmic bodies), +/-[[nucleoli]] common, round nuclei | ||
| Subtypes = | | Subtypes = benign (common), malignant (rare) | ||
| LMDDx = [[spermatocytic | | LMDDx = [[spermatocytic tumour]] (testis only), [[pregnancy luteoma]] (females only), [[Sertoli-Leydig cell tumour]], [[Leydig cell hyperplasia]] | ||
| Stains = | | Stains = | ||
| IHC = inhibin-alpha +ve, calretinin +ve, melan A +ve | | IHC = inhibin-alpha +ve, calretinin +ve, melan A +ve | ||
| Line 13: | Line 14: | ||
| IF = | | IF = | ||
| Gross = solid, red/tan | | Gross = solid, red/tan | ||
| Grossing = | | Grossing = [[orchiectomy grossing]] | ||
| Site = [[testis]] | | Site = [[testis]], [[ovary]] (rare) | ||
| Assdx = | | Assdx = | ||
| Syndromes = | | Syndromes = | ||
| Line 21: | Line 22: | ||
| Symptoms = | | Symptoms = | ||
| Prevalence = uncommon | | Prevalence = uncommon | ||
| Bloodwork = +/-elevated testosterone | | Bloodwork = +/-elevated testosterone (rarely elevated estradiol) | ||
| Rads = | | Rads = | ||
| Endoscopy = | | Endoscopy = | ||
| Prognosis = benign | | Prognosis = usu. benign, occasionally malignant | ||
| Other = | | Other = | ||
| ClinDDx = other testicular tumours | | ClinDDx = other testicular tumours | ||
}} | }} | ||
'''Leydig cell tumour''', also known as '''interstitial cell tumour''', is an uncommon benign sex cord-stromal tumour, typically seen in the [[testis]]. | '''Leydig cell tumour''' (abbreviated '''LCT'''), also known as '''interstitial cell tumour''', is an uncommon benign sex cord-stromal tumour, typically seen in the [[testis]]. | ||
''Interstitial cell tumour'' should '''not''' be confused with ''[[renomedullary interstitial cell tumour]]''. | ''Interstitial cell tumour'' should '''not''' be confused with ''[[renomedullary interstitial cell tumour]]''. | ||
| Line 36: | Line 36: | ||
*Arises from the interstitial cell. | *Arises from the interstitial cell. | ||
*May be associated with increased testosterone. | *May be associated with increased testosterone. | ||
*Can be malignant in adults.<ref name=pmid17284120>{{Cite journal | last1 = Al-Agha | first1 = OM. | last2 = Axiotis | first2 = CA. | title = An in-depth look at Leydig cell tumor of the testis. | journal = Arch Pathol Lab Med | volume = 131 | issue = 2 | pages = 311-7 | month = Feb | year = 2007 | doi = 10.1043/1543-2165(2007)131[311:AILALC]2.0.CO;2 | PMID = 17284120 | URL = http://www.archivesofpathology.org/doi/full/10.1043/1543-2165%282007%29131%5B311:AILALC%5D2.0.CO;2 }}</ref> | |||
*May be seen in the [[ovary]].<ref name=pmid20518640>{{Cite journal | last1 = Yetkin | first1 = DO. | last2 = Demirsoy | first2 = ET. | last3 = Kadioglu | first3 = P. | title = Pure leydig cell tumour of the ovary in a post-menopausal patient with severe hyperandrogenism and erythrocytosis. | journal = Gynecol Endocrinol | volume = 27 | issue = 4 | pages = 237-40 | month = Apr | year = 2011 | doi = 10.3109/09513590.2010.490611 | PMID = 20518640 }}</ref> | |||
Clinical:<ref name=pmid17284120/> | |||
*+/-Elevated testosterone. | |||
**Rarely elevated estradiol. | |||
*ACTH low. | |||
==Gross== | ==Gross== | ||
*Solid, lobulated. | *Solid, lobulated. | ||
*Red/tan. | *Red/tan. | ||
*Typically 3-5 cm.<ref name=pmid17284120/> | |||
Image: | Image: | ||
| Line 48: | Line 55: | ||
*Vacuolization (cytoplasm) - '''key feature'''. | *Vacuolization (cytoplasm) - '''key feature'''. | ||
*Cytoplasm - clear to eosinophilic - '''important'''. | *Cytoplasm - clear to eosinophilic - '''important'''. | ||
**Usually eosinophilic. | |||
*''Reinke crystals'' - classic finding, usually not present. | *''Reinke crystals'' - classic finding, usually not present. | ||
**Cylindrical crystalloid eosinophilic cytoplasmic bodies. | **Cylindrical crystalloid eosinophilic cytoplasmic bodies. | ||
*Nucleoli common. | *Nucleoli common. | ||
*Round nuclei. | *Round nuclei. | ||
Features of malignancy in Leydig cell tumours:<ref name=pmid21691571>{{Cite journal | last1 = Vasilakaki | first1 = T. | last2 = Michalis | first2 = L. | last3 = Skafida | first3 = E. | last4 = Arkoumani | first4 = E. | last5 = Delliou | first5 = E. | last6 = Grammatoglou | first6 = X. | last7 = Kontovourkis | first7 = P. | last8 = Papamichail | first8 = V. | last9 = Stamatiou | first9 = K. | title = An unusual case of unilateral malignant leydig cell tumour of the testis. | journal = Case Rep Oncol | volume = 4 | issue = 1 | pages = 132-5 | month = Jan | year = 2011 | doi = 10.1159/000326800 | PMID = 21691571 }}</ref><ref name=pmid9808128>{{Cite journal | last1 = Cheville | first1 = JC. | last2 = Sebo | first2 = TJ. | last3 = Lager | first3 = DJ. | last4 = Bostwick | first4 = DG. | last5 = Farrow | first5 = GM. | title = Leydig cell tumor of the testis: a clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. | journal = Am J Surg Pathol | volume = 22 | issue = 11 | pages = 1361-7 | month = Nov | year = 1998 | doi = | PMID = 9808128 }}</ref> | |||
*Large size (4.7 cm in metastatic LCT vs. 2.6 cm in nonmetastatic LCT<ref name=pmid9808128/>). | |||
*Infiltrative margins. | |||
*Lymphovascular invasion. | |||
*Necrosis. | |||
*Nuclear atypia. | |||
*Mitoses (>3/10 HPF). | |||
*High Ki-67 (18.6% in metastatic LCT vs. 1.2% cm in nonmetastatic LCT<ref name=pmid9808128/>). | |||
DDx: | DDx: | ||
*[[Spermatocytic | *[[Spermatocytic tumour]] (previously ''spermatocytic seminoma'') - may have eosinophilic cytoplasm. | ||
*[[Pregnancy luteoma]] - occurs during pregnancy, as the name implies. | *[[Pregnancy luteoma]] - occurs during pregnancy, as the name implies. | ||
*[[Leydig cell hyperplasia]]. | |||
*[[Granular cell tumour]].<ref name=pmid17284120/> | |||
===Images=== | ===Images=== | ||
| Line 65: | Line 84: | ||
www: | www: | ||
*[http://path.upmc.edu/cases/case404.html Leydig cell tumour - several images (upmc.edu)]. | *[http://path.upmc.edu/cases/case404.html Leydig cell tumour - several images (upmc.edu)]. | ||
*[http://www.webpathology.com/image.asp?case=38&n=3 Reinke crystals (webpathology.com)]. | |||
*[https://www.pinterest.com/pin/520447300659777928/ Reinke crystals (pinterest.com)]. | |||
*[https://www.pinterest.com/pin/499829258616698163/ Reinke crystals (pinterest.com)]. (???) | |||
==IHC== | ==IHC== | ||
| Line 72: | Line 94: | ||
**[[AKA]] ''MART-1''. | **[[AKA]] ''MART-1''. | ||
**Expressed in [[melanoma]], [[adrenal gland|adrenal tissue]], steroid-secreting tumours. | **Expressed in [[melanoma]], [[adrenal gland|adrenal tissue]], steroid-secreting tumours. | ||
*Vimentin +ve.<ref name=pmid17284120/> | |||
*[[SALL4]] -ve (10 of 10 cases).<ref name=pmid19390421>{{cite journal |authors=Cao D, Li J, Guo CC, Allan RW, Humphrey PA |title=SALL4 is a novel diagnostic marker for testicular germ cell tumors |journal=Am J Surg Pathol |volume=33 |issue=7 |pages=1065–77 |date=July 2009 |pmid=19390421 |doi=10.1097/PAS.0b013e3181a13eef |url=}}</ref> | |||
==Sign out== | |||
<pre> | |||
Mass of Right Testicle, Radical Orchiectomy: | |||
- Leydig cell tumour. | |||
Comment: | |||
The tumour consists of polygonal cells with abundant eosinophilic | |||
cytoplasm, round nuclei with prominent nucleoli. | |||
Features suggestive of malignancy are absent. | |||
The tumour stains with calretinin, Melan A and inhibin. It is | |||
negative for AE1/AE3, and OCT4. This supports the diagnosis | |||
of Leydig cell tumour. | |||
</pre> | |||
==See also== | ==See also== | ||