Difference between revisions of "Leydig cell tumour"

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#redirect [[Testis#Leydig_cell_tumour]]
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Leydig_cell_tumour3.jpg
| Width      =
| 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
| Subtypes  = benign (common), malignant (rare)
| LMDDx      = [[spermatocytic tumour]] (testis only), [[pregnancy luteoma]] (females only), [[Sertoli-Leydig cell tumour]], [[Leydig cell hyperplasia]]
| Stains    =
| IHC        = inhibin-alpha +ve, calretinin +ve, melan A +ve
| EM        =
| Molecular  =
| IF        =
| Gross      = solid, red/tan
| Grossing  = [[orchiectomy grossing]]
| Site      = [[testis]], [[ovary]] (rare)
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      =
| Symptoms  =
| Prevalence = uncommon
| Bloodwork  = +/-elevated testosterone (rarely elevated estradiol)
| Rads      =
| Endoscopy  =
| Prognosis  = usu. benign, occasionally malignant
| Other      =
| ClinDDx    = other testicular tumours
}}
'''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]]''.
 
==General==
*Arises from the interstitial cell.
*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==
*Solid, lobulated.
*Red/tan.
*Typically 3-5 cm.<ref name=pmid17284120/>
 
Image:
*[http://www.flickr.com/photos/35441329@N05/5056465301/sizes/m/in/photostream/ Leydig cell tumour (flickr.com)].
 
==Microscopic==
Features:<ref name=Ref_GUP581>{{Ref GUP|581}}</ref>
*Vacuolization (cytoplasm) - '''key feature'''.
*Cytoplasm - clear to eosinophilic - '''important'''.
**Usually eosinophilic.
*''Reinke crystals'' - classic finding, usually not present.
**Cylindrical crystalloid eosinophilic cytoplasmic bodies.
*Nucleoli common.
*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:
*[[Spermatocytic tumour]] (previously ''spermatocytic seminoma'') - may have eosinophilic cytoplasm.
*[[Pregnancy luteoma]] - occurs during pregnancy, as the name implies.
*[[Leydig cell hyperplasia]].
*[[Granular cell tumour]].<ref name=pmid17284120/>
 
===Images===
<gallery>
Image:Leydig_cell_tumour1.jpg |Leydig cell tumour - low mag. (WC)
Image:Leydig_cell_tumour2.jpg |Leydig cell tumour - intermed. mag. (WC)
Image:Leydig_cell_tumour3.jpg |Leydig cell tumour - high mag. (WC)
</gallery>
www:
*[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==
*Inhibin-alpha +ve.
*Calretinin +ve.<ref>URL: [http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm]. Accessed on: 18 May 2010.</ref><ref name=pmid15950053>{{cite journal |author=Bar-Shira Maymon B, Yavetz H, Yogev L, ''et al.'' |title=Detection of calretinin expression in abnormal immature Sertoli cells in non-obstructive azoospermia |journal=Acta Histochem. |volume=107 |issue=2 |pages=105–12 |year=2005 |pmid=15950053 |doi=10.1016/j.acthis.2005.02.002 |url=}}</ref>
*Melan A +ve.<ref name=pmid12966351>{{cite journal |author=Yao DX, Soslow RA, Hedvat CV, Leitao M, Baergen RN |title=Melan-A (A103) and inhibin expression in ovarian neoplasms |journal=Appl. Immunohistochem. Mol. Morphol. |volume=11 |issue=3 |pages=244–9 |year=2003 |month=September |pmid=12966351 |doi= |url=}}</ref>
**[[AKA]] ''MART-1''.
**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==
*[[Testis]].
*[[Sertoli-Leydig tumour]].
 
==References==
{{Reflist|2}}
 
[[Category:Testis]]
[[Category:Diagnosis]]

Latest revision as of 20:31, 31 January 2022

Leydig cell tumour (abbreviated LCT), also known as interstitial cell tumour, is an uncommon benign sex cord-stromal tumour, typically seen in the testis.

Leydig cell tumour
Diagnosis in short

Leydig cell tumour. H&E stain.
Synonyms interstitial cell tumour
LM cytoplasmic vacuolization, cytoplasm -- clear to eosinophilic, +/-Reinke crystals (cylindrical crystalloid -- eosinophilic cytoplasmic bodies), +/-nucleoli common, round nuclei
Subtypes benign (common), malignant (rare)
LM DDx spermatocytic tumour (testis only), pregnancy luteoma (females only), Sertoli-Leydig cell tumour, Leydig cell hyperplasia
IHC inhibin-alpha +ve, calretinin +ve, melan A +ve
Gross solid, red/tan
Grossing notes orchiectomy grossing
Site testis, ovary (rare)
Prevalence uncommon
Blood work +/-elevated testosterone (rarely elevated estradiol)
Prognosis usu. benign, occasionally malignant
Clin. DDx other testicular tumours

Interstitial cell tumour should not be confused with renomedullary interstitial cell tumour.

General

  • Arises from the interstitial cell.
  • May be associated with increased testosterone.
  • Can be malignant in adults.[1]
  • May be seen in the ovary.[2]

Clinical:[1]

  • +/-Elevated testosterone.
    • Rarely elevated estradiol.
  • ACTH low.

Gross

  • Solid, lobulated.
  • Red/tan.
  • Typically 3-5 cm.[1]

Image:

Microscopic

Features:[3]

  • Vacuolization (cytoplasm) - key feature.
  • Cytoplasm - clear to eosinophilic - important.
    • Usually eosinophilic.
  • Reinke crystals - classic finding, usually not present.
    • Cylindrical crystalloid eosinophilic cytoplasmic bodies.
  • Nucleoli common.
  • Round nuclei.

Features of malignancy in Leydig cell tumours:[4][5]

  • Large size (4.7 cm in metastatic LCT vs. 2.6 cm in nonmetastatic LCT[5]).
  • 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[5]).

DDx:

Images

  • Leydig cell tumour - low mag. (WC)

  • Leydig cell tumour - intermed. mag. (WC)

  • Leydig cell tumour - high mag. (WC)

www:

IHC

Sign out

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.

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 Al-Agha, OM.; Axiotis, CA. (Feb 2007). "An in-depth look at Leydig cell tumor of the testis.". Arch Pathol Lab Med 131 (2): 311-7. doi:10.1043/1543-2165(2007)131[311:AILALC]2.0.CO;2. PMID 17284120.
  2. ↑ Yetkin, DO.; Demirsoy, ET.; Kadioglu, P. (Apr 2011). "Pure leydig cell tumour of the ovary in a post-menopausal patient with severe hyperandrogenism and erythrocytosis.". Gynecol Endocrinol 27 (4): 237-40. doi:10.3109/09513590.2010.490611. PMID 20518640.
  3. ↑ Zhou, Ming; Magi-Galluzzi, Cristina (2006). Genitourinary Pathology: A Volume in Foundations in Diagnostic Pathology Series (1st ed.). Churchill Livingstone. pp. 581. ISBN 978-0443066771.
  4. ↑ Vasilakaki, T.; Michalis, L.; Skafida, E.; Arkoumani, E.; Delliou, E.; Grammatoglou, X.; Kontovourkis, P.; Papamichail, V. et al. (Jan 2011). "An unusual case of unilateral malignant leydig cell tumour of the testis.". Case Rep Oncol 4 (1): 132-5. doi:10.1159/000326800. PMID 21691571.
  5. ↑ 5.0 5.1 5.2 Cheville, JC.; Sebo, TJ.; Lager, DJ.; Bostwick, DG.; Farrow, GM. (Nov 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 (11): 1361-7. PMID 9808128.
  6. ↑ URL: http://www.antibodybeyond.com/reviews/cell-markers/leydig-cell-marker.htm. Accessed on: 18 May 2010.
  7. ↑ Bar-Shira Maymon B, Yavetz H, Yogev L, et al. (2005). "Detection of calretinin expression in abnormal immature Sertoli cells in non-obstructive azoospermia". Acta Histochem. 107 (2): 105–12. doi:10.1016/j.acthis.2005.02.002. PMID 15950053.
  8. ↑ Yao DX, Soslow RA, Hedvat CV, Leitao M, Baergen RN (September 2003). "Melan-A (A103) and inhibin expression in ovarian neoplasms". Appl. Immunohistochem. Mol. Morphol. 11 (3): 244–9. PMID 12966351.
  9. ↑ Cao D, Li J, Guo CC, Allan RW, Humphrey PA (July 2009). "SALL4 is a novel diagnostic marker for testicular germ cell tumors". Am J Surg Pathol 33 (7): 1065–77. doi:10.1097/PAS.0b013e3181a13eef. PMID 19390421.
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