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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2011  |  Volume : 22  |  Issue : 2  |  Page : 354-356
Leydig cell tumor with mediastinal and lung metastasis

Department of Urology, IPGMER & SSKM, Kolkata-20, West Bengal, India

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Date of Web Publication18-Mar-2011

How to cite this article:
Tiwari P, Goel A, Sharma P, Kumar S, Vijay M, Dutta A. Leydig cell tumor with mediastinal and lung metastasis. Saudi J Kidney Dis Transpl 2011;22:354-6

How to cite this URL:
Tiwari P, Goel A, Sharma P, Kumar S, Vijay M, Dutta A. Leydig cell tumor with mediastinal and lung metastasis. Saudi J Kidney Dis Transpl [serial online] 2011 [cited 2021 Sep 25];22:354-6. Available from: https://www.sjkdt.org/text.asp?2011/22/2/354/77640
To the Editor,

The interstitial cells of Leydig develop from the mesenchyme located between the semini­ferous tubules in the testis. [1] Leydig Cell tu­mors are rare and account for only 3% of tes­ticular tumors [2] and are generally benign. Ma­lignant Leydig cell tumor (LCT) of the testis accounts for less than 0.2% of all testicular cancers as evidenced by metastatic spread and poor survival. [3] We report an interesting case of malignant LCT with mediastinal and lung me­tastasis in a 38-year-old man who presented with a complaint of dry cough for three months. Physical examination was normal except for a left testicular mass of approximate size 5 × 5 × 4 cm, which was smooth, hard and did not transilluminate. No induration of spermatic cord, no gynecomastia and no palpable lymphadeno­pathy was found. The patient revealed that he was married for 23 years and had primary in­fertility for which he received no treatment. Ultrasonography of the scrotum and abdomen showed normal right testis and left testicular space occupying lesion of size 5 × 5 × 4 cm with gross calcification. No retroperitoneal lym­phadenopathy or liver metastases were seen. Chest X-ray showed multiple rounded opaci­ties in both lung fields with mediastinal wi­dening. Contrast computed tomography (CT) scan of the thorax suggested multiple secon­daries in both lungs with posterior mediastinal nodal mass and enlarged precarinal nodes [Figure 1]. CT scan of the abdomen was normal. B-HCG measured 1.2 mIU/mL, alfa-feto protein 7.99 IU/mL, and lactate dehydrogenase (LDH) activity was 254 IU/L. Semen analysis revealed azoospermia. Serum testosterone, es­trogen and 24-hour urine 17-ketosteroids le­vels were normal.
Figure 1: Contrast CT (A– C) of thorax: multiple secondaries in both lungs with a posterior mediastinal nodal mass and enlarged precarinal nodes.

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A high left inguinal orchiectomy was per­formed. On gross examination, tumor mass showed calcification and tan colored areas. Light and electron microscopy showed tumor composed of lobules and sheet of liver like cells separated by fine fibrovascular septae. [Figure 2]. Mediastinoscopy and biopsy re­vealed metastatic tumor consistent with LCT. The patient declined further chemotherapy and died 3 months later with massive lung hemo­rrhage.
Figure 2. (A– C) Low power view shows solid nests of cells spareted by thin fibrous tissue septae,
individual cells having eosinophillic cytoplasm with central rounded nucleus. Cytoplasm vacuolated in appearence (HE stain 10×). (D, E) High power view shows individual cells having abundant eosinophillic cytoplasm with central round to oval neucleus with inconspicuous nuclei (HE stain 40×).

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The histology of Leydig cell cancer has been well described. [4] However, the most accepted criterion of malignancy remains the presence of metastasis. From the previously reported cases, it can be said that metastatic LCT oc­curred in patients between 20 and 82 years, with a mean age of 58 years. [5] Approximately, 20% patients had metastatic disease at the time of initial diagnosis, with another 40% having metastatic disease within two years. Most fre­quent sites of metastasis were the regional lymph nodes including the inguinal, iliac, and retroperitoneal lymph node groups (70%), fol­lowed by liver (45%), lung (40%), and bones (25%). [2],[4]

The survival after diagnosis of the primary LCT disease ranged from 2 months to 17 years. However, median survival was two years. [6] Survival after diagnosis of metastatic disease ranged from less than one month to nine years. However, two-third patients died within two years of developing metastasis. [2],[4]

Radiotherapy has only a palliative role to provide pain relief in bony and retroperitoneal metastasis. No standard chemotherapy regimen had proven role. [6] The case reported here was 38 years old and his survival was three months after diagnosis of metastatic disease to medias­tinum and lungs. Patient had primary infertility and azoospermia and a normal endocrine evaluation.This case illustrates the short survival and bad prognosis in a patient of metastatic Leydig cell tumor. [7] These patients should be considered for investigational protocols eva­luating new antineoplastic agents. [8]

   References Top

1.Langman J. Medical Embryology, ed. 3. Bal­timore: Williams and Wilkins, 1975;175-8.  Back to cited text no. 1
2.Kim I, Young RH, Scully RE. Leydig cell tumors of the testis. Am J Surg Pathol 1985;9:177-92.  Back to cited text no. 2
3.Lam JS, Borczuk AC, Franklin JR. Metastatic Leydig cell tumor of the testicle in a young African American male. Can J Urol 2003;10 (6):2074-6.  Back to cited text no. 3
4.Symington T, Cameron KM. Endocrine and Genetic Lesions. In: Pugh RCB, ed. Pathology of the Testis. London: Blackwell; 1976;265-­303.  Back to cited text no. 4
5.Azer PC, Braunstein GD. Malignant Leydig cell tumor: Objective response to o,p'DDD. Cancer 1981;47:1251-5.  Back to cited text no. 5
6.Bertram KA, Bratloff B. Treatment of malig­nant leydig cell tumor. Cancer 1991;68:2324­-9.  Back to cited text no. 6
7.Bertram KA, Bratloff B, Hodges GF, Davidson H. Treatment of malignant Leydig cell tumor. Cancer.1991;68(10):2324-9.  Back to cited text no. 7
8.Bhat GM, Lone MI, Alsolami S, Iqbal QM. Recurrent malignant leydig cell tumor of testis: a case report with review of literature. Gulf J Oncol 2010;7:42-5.  Back to cited text no. 8

Correspondence Address:
Punit Tiwari
Department of Urology, IPGMER & SSKM, Kolkata-20, West Bengal
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PMID: 21422645

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