Difference between revisions of "Leydig cell tumour"

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Leydig cell tumour (view source)

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Leydig_cell_tumour2.jpg
| Image      = Leydig_cell_tumour3.jpg  
| Width      =
| Width      =
| Caption    = Leydig cell tumour. [[H&E stain]].
| Caption    = Leydig cell tumour. [[H&E stain]].
| Micro      = cytoplasmic vacuolization, cytoplasm - clear to eosinophilic, +/-''Reinke crystals'' (cylindrical crystalloid - eosinophilic cytoplasmic bodies), +/-[[nucleoli]] common, round nuclei
| Synonyms  = interstitial cell tumour
| Subtypes  =
| Micro      = cytoplasmic vacuolization, cytoplasm -- clear to eosinophilic, +/-''Reinke crystals'' (cylindrical crystalloid -- eosinophilic cytoplasmic bodies), +/-[[nucleoli]] common, round nuclei
| LMDDx      = [[spermatocytic seminoma]] (testis only), [[pregnancy luteoma]] (females only), [[Sertoli-Leydig cell tumour]]
| Subtypes  = benign (common), malignant (rare)
| 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
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| IF        =
| IF        =
| Gross      = solid, red/tan
| Gross      = solid, red/tan
| Grossing  =
| Grossing  = [[orchiectomy grossing]]
| Site      = [[testis]]
| Site      = [[testis]], [[ovary]] (rare)
| Assdx      =
| Assdx      =
| Syndromes  =
| Syndromes  =
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| 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]]''.


==General==
==General==
*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:
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*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 seminoma]] - may have eosinophilic cytoplasm.
*[[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===
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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==
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**[[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==
Michael
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