Leydig cell tumour

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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

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.[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.