Malignant interstitial (Leydig) cell tumour of the testis--a case report

Interstitial (Leydig) cell tumour of the testis is an extremely uncommon tumour. We report one such tumour displaying histologic features of malignancy--large size capsular invasion and moderate nuclear pleomorphism in an adult male. The tumour also showed crystalloids of Reinke, confirming Leydig cell origin.

[Leydig cell tumors of the testis--clinical and morphologic aspects]

Leydig cell tumors are the most common tumors of the gonadal stroma. They account for 3% of all testicular tumors. Whereas in 10% of adult cases malignancy occurs, the clinical course in children is benign. During childhood the tumor presents with precocious pseudopuberty, in adults with testicular swelling and gynecomastia. We report on 17 cases of Leydig cell tumor, paying special attention to clinical and morphological aspects.

[Two new Leydig cell testicular tumors presenting with gynecomastia in adults]

Presentation of two cases of Leydig cell tumor in adult patients who presented with gynecomastia, and slightly abnormal hormonal profiles. One patient had a non palpable tumor. The pathophysiology of this entity is commented, as well as the importance of the different modalities in its diagnosis.

Unexpected ovarian malignancy diagnosed after laparoscopic surgery

The main concerns for laparoscopic management of ovarian masses are unexpected malignancy and the spillage of the cyst content. Careful preoperative evaluation is important in proper patient selection. We report a case of unexpected ovarian malignancy managed by operative laparoscopy in a 29-year-old woman. The role of ultrasonographic and laparoscopic assessment and their limitations are discussed. The potential role of intraoperative laparoscopic ultrasonographic assessment of the ovarian masses is proposed.

[Testicular tumors in dogs: a literature review]

The incidence of testicular tumours in dogs is higher than in other species. The main three types are: Sertoli cell tumour, seminoma, and Leydig cell tumour. Metastases are rare. Sertoli cell tumours, and to a lesser extent Leydig cell tumours, are often associated with feminization, which occurs in 19% and 5% of cases, respectively. Seminomas are rarely associated with feminization. Feminization seems to be the result of an excessive oestrogen production by the tumour. In severe cases this may lead to bone marrow depression. Atrophy of the contralateral testis is a common finding. It is not clear whether this is a result of feminization or of age because most tumours occur in older dogs. By investigating the morphology of the testis, and the endocrinological and fertility status of the dog this phenomena is hopefully going to be explained. Extra attention is given to the pathogenesis of feminization.

Excessive testosterone production in a patient with Nelson syndrome and bilateral testicular tumors

Bilateral primary testicular tumors are rare and usually consist of either interstitial cells or hypertrophic testicular adrenal remnant tissue. Their differentiation on clinical presentation and histologic examination remains difficult but is essential because of the different therapeutic approaches. We report a rare case of excessive testosterone production by bilateral testicular tumors in a patient with Nelson syndrome (ACTH-secreting pituitary adenoma after bilateral adrenalectomy in patients with Cushing's disease). Increased ACTH stimulation in this patient supports the thesis of pluripotent cells within the testis which can undergo differentiation to cells which are not only morphologically similar to Leydig cells but also have the functional property of these cells. Our clinical findings support the diagnosis of hyperplasia of adrenal remnant or pluripotent cells rather than a true Leydig cell tumor. We emphasize the need for hormonal evaluations which should be assessed in the context of the size of these nodular tumors prior to therapeutic decisions. In cases with elevated serum ACTH and small nodular hyperplasia, we would favor a 'wait-and-see' strategy with appropriate hormonal therapy. In large tumors with clinical signs of hormonal activity, patient noncompliance with steroid replacement regimens or with local symptoms, scrotal exploration and tumor enucleation are indicated.

Leydig cell tumour in a man with human immunodeficiency virus

We report a case of Leydig-cell testicular tumour in a 32-year-old intravenous drug abuser bearing HIV-infection and pulmonary tuberculosis. The testicular mass was initially interpreted as genital tuberculosis and the diagnosis was made by aspiration cytology. Radical orchiectomy was performed and pathology revealed a Leydig-cell tumour. Gynecomastia was found as a possible sign of endocrine activity. Although testicular malignancies in men with human immunodeficiency virus are increasingly reported, this is the first case of Leydig-cell neoplasia associated to HIV-infection.

[Synchronous bilateral testicular tumor: embryonal carcinoma and Leydig cell tumor]

Synchronous bilateral testis tumours of different histologic types are rare, especially the simultaneous occurrence of germ cell and contralateral stromal tumours. The case of an embryonal carcinoma and contralateral Leydig cell tumour is presented and discussed in consideration of the topical literature.

Interstitial cell adenoma of the rat testis: why is it such a problem in toxicology studies using Sprague-Dawley rats?

Arbitrary criteria can give unreliable diagnoses. Conditions that occupy the same marginal diagnostic space, such as interstitial cell hyperplasia and interstitial cell adenoma, sometimes will be mistaken for one another. When the true prevalence is low, the risk of false positives, as a percentage of all positives, is high. The preceding analysis predicts that, with currently recommended diagnostic criteria, any compound that causes nonneoplastic interstitial cell hyperplasia will be interpreted to cause interstitial cell neoplasia if SD rats are used and only microscopic diagnoses are considered. Conversely, the analysis predicts that no compound that actually causes neoplasia in interstitial cells will be identified as an interstitial cell tumorigen if F-344 rats are used and only microscopic diagnoses are considered. These predictions are consistent with experience.

Bilateral Leydig cell tumors with unilateral cryptorchidism. Case report

Bilateral leydig cell tumors of testes are very rare. There is no evidence from literature that in the cryptorchid man, bilateral leydig cell tumors are prone to develop. We report a man with bilateral leydig cell tumors in association with unilateral cryptorchidism.

[Leydig cell tumor. Comments on 5 cases]

Leydig's cells tumours are a variant of testicular tumours. Its has a low incidence, accounting for just 1-3% of all testicular tumours. This tumour is characterized by its endocrine manifestations, and it is an element in the differential diagnosis of many endocrine sexual dysfunctions both in adults and children, due to the tumour's capacity to secrete hormones. This paper contributes 5 cases of Leydig's cells tumours diagnosed in our hospital between 1977 and 1993.

Intranuclear Reinke's crystals in a testicular Leydig cell tumor diagnosed by aspiration cytology. A case report

Fine needle aspiration cytologic findings in a Leydig cell tumor of the testis are described. Besides the rarity of case reports on fine needle aspiration cytologic diagnosis of this tumor, the present case was of interest because of the finding of numerous intranuclear and intracytoplasmic Reinke's crystals as well as some lying free between the cells. In a few cells the intranuclear crystals were seen to orient themselves in a row, with a nipplelike protrusion of the nuclear membrane as if being pushed by the crystals. Besides the well-formed crystals, many nuclei showed irregular, thin, groovelike spaces that may have been earlier stages of crystal formation. These findings suggested the intranuclear formation of Reinke's crystals. Extranuclear crystals were seen to fuse in pairs and hence to appear thicker than the intranuclear crystals. The crystals lying free between the cells also showed a linear arrangement in places. The crystals were more numerous with May-Grünwald-Giemsa (MGG) staining. Intranuclear crystals were seen only in MGG-stained smears.

Leydig cell tumor of intra-abdominal testis

A patient with bilateral cryptorchidism and gynecomastia due to Leydig cell tumor involving the left intra-abdominal testis is described. Raised serum estrogen, low serum testosterone, and ultrasonic demonstration of a tumor in the left testis allowed the diagnosis to be suspected preoperatively. The relevant literature is reviewed.

Leydig cell tumor of the testis in Klinefelter syndrome: MR detection

Klinefelter syndrome is associated with the development of breast and extragonadal germ cell tumors in some patients. Leydig cell tumor in association with Klinefelter syndrome is a rare entity. We report such a case to illustrate the usefulness of MR imaging in detecting a testicular neoplasm when clinical examination and ultrasonography are equivocal.

[Sertoli-Leydig-cell ovarian tumor with a retiform pattern and heterologous elements: a rare cause of virilization]

The case is presented of a young female with virilization signs and total circulating testosterone levels above 4 ng/ml, without a concomitant increase in cortisol, 17 OH-progesterone, DHEA-S, or androstenedion levels. On CT scan exam a tumoral mass in the left ovary was observed with polycystic characteristics similar to those observed in ovarian cystadenoma, inspite of the fact that most androgenic ovarian tumors are solid. The pathological study revealed an ovarian Sertoli-Leydig tumor associated to a reticular pattern with heterologous chondroid and mucinoid elements of cystadenoma.

[Magnetic resonance tomography in the differential diagnosis of pathologic changes in scrotal contents--a comparison with computed tomography]

48 patients with scrotal pathology were examined by magnetic resonance tomography (MRI) and computed tomography (CT). The diagnostic results were compared to surgical and histological findings. The correct diagnosis could be detected in 81% by CT and in 85% by MR. Another 27 patients were examined only by MR with positive results in 88%. Demonstration of tunica albuginea, imaging of testes in various planes and diagnostic accuracy in about 88% with missing ionising irradiation make MRI the most reliable diagnostic imaging in the classification of scrotal pathology. False negative results were found in 1/48 by CT and none by MRI. False positive results could be found in 2/75 of MRI examinations but none in CT.

Early indicators for carcinogenesis in sex-hormone-sensitive organs

Hormones induce tumours in various target tissues in different species of laboratory animals in long-term toxicity studies. Examples of such tumours are: mammary gland tumours in beagle dogs after long-term treatment with progestogens or progestogen/oestrogen combinations; pituitary and mammary gland tumours in rats and mice after long-term treatment with oestrogens or progestogens with an oestrogenic partial effect; interstitial cell tumours in rats after chronic overstimulation by endogenous luteinising hormone; endometrial carcinomas in rats after chronic treatment with dopamine agonists. As a rule every hormone when given in excessive doses over prolonged periods can induce a tumour in the relevant target organs. Drugs or chemicals which stimulate or inhibit the endogenous hormone production of certain endocrine organs can have the same effect. Tumour induction can be a direct or indirect effect involving specific regulatory mechanisms. In general, the induction is preceded by excessive hyperplasia of the target tissue concerned or with regard to the pituitary where excess production of the stimulating hormone occurs. Tumour induction in chronic toxicity studies can usually be predicted by determining hormone levels in short-term studies. Hormones and drugs or chemicals which induce tumours when given in doses high enough to induce hyperplasia are unlikely to do so by a genotoxic mechanism.

Sebum measurements for rapid identification of hyperandrogenism due to an ovarian Leydig cell tumor

Direct measurements of sebum with the Sebumeter were used in a patient with a benign androgen-producing tumor of the ovary. Androgen levels fell immediately after surgery, whereas the markedly elevated sebum levels found preoperatively dropped to normal after a delay of more than 2 weeks. Therefore, the Subumeter, due to its simplicity, may be useful for the preliminary screening and follow-up of patients with hyperandrogenic states.

Bilateral stromal Leydig cell tumour of the ovary. Case report and literature review

The stromal Leydig cell tumour of the ovary is a very rare benign neoplasm which usually occurs in postmenopausal women. Due to a significant production of androgens by the tumour, it is frequently associated with symptoms of virilization. To our knowledge only 7 cases have been reported in the literature, one of them with bilateral manifestation. We report an additional case affecting both ovaries in a 59-year-old nun with long-standing virilism, review the literature, and discuss the histomorphological features for differential diagnosis.