Leydig cell tumour

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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

www:

IHC

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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.