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Yamamoto Y, Taiji R, Takewa M, Kitatsuji W, Okura A, Saito N, Ohyama N, Tachiiri T, Nishiofuku H, Itoh T, Marugami N, Tanaka T. Leydig cell tumor of the testis with characteristic contrast patterns of tumor and non-tumorous testicular parenchyma on MRI: a case report. Abdom Radiol (NY) 2023; 48:2477-2482. [PMID: 37165207 DOI: 10.1007/s00261-023-03932-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/19/2023] [Accepted: 04/20/2023] [Indexed: 05/12/2023]
Abstract
PURPOSE Testicular Leydig cell tumor (LCT) is a rare subtype of testicular neoplasms that occurs in the interstitial tissue of testes, accounting for 1-3% of total testicular masses removed annually. We report a case of 70-year-old man diagnosed as testicular LCT. This report demonstrates a testicular LCT with intratumoral and non-tumorous testicular parenchymal enhancement in the affected testis, which should be considered characteristic findings of LCT. METHODS Ultrasonography showed a hypoechoic mass. On magnetic resonance imaging, the tumor showed low signal intensity comparable to the surrounding testicular tissue on T1-weighted images (T1WI) and low signal intensity on T2-weighted images (T2WI). On gadolinium contrast-enhanced T1WI (CE-T1WI), the tumor showed a rapid and marked wash-in and subsequent prolonged washout. The spared, non-tumorous testicular parenchyma showed slow and progressive enhancement in the early phase, which was as strong as or stronger than that of the mass in the delayed phase. The patient underwent right orchiectomy. RESULTS Pathologically, the tumor was diagnosed as a testicular Leydig cell tumor (LCT). Leydig cell proliferation was observed with well-developed microvessels, atrophy of the seminiferous tubules, and stromal edema in the non-tumorous testicular parenchyma. Leydig cells in the non-tumorous parenchyma were positive for estrogen receptors. CONCLUSION Since the contrast findings in the non-tumorous testicular parenchymal region on CE-T1WI likely match the histopathological features of LCT, our case suggests that the presence of non-tumorous testicular parenchymal enhancement on imaging might indicate a diagnosis of LCT.
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Affiliation(s)
- Yuji Yamamoto
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Ryosuke Taiji
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan.
| | - Megumi Takewa
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Wataru Kitatsuji
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Akira Okura
- Department of Radiology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Naotoshi Saito
- Department of Pathology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Nobuo Ohyama
- Department of Urology, Nara Prefectural Seiwa Medical Center, 1-14-16, Mimuro, Ikoma-Gun, Sangou-Cho, Nara, 636-0802, Japan
| | - Tetsuya Tachiiri
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Hideyuki Nishiofuku
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Takahiro Itoh
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Nagaaki Marugami
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
| | - Toshihiro Tanaka
- Department of Diagnostic and Interventional Radiology, Nara Medical University, 840, Shijo-Cho, Kashihara-City, Nara, 634-8522, Japan
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Brown D, Tsampoukas G. Loss of libido in a man with an incidental Leydig cell tumour of the testis: a rare tumour discovered following an isolated common complaint. J Surg Case Rep 2020; 2020:rjaa241. [PMID: 33343871 PMCID: PMC7733531 DOI: 10.1093/jscr/rjaa241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 06/14/2020] [Accepted: 06/16/2020] [Indexed: 11/29/2022] Open
Abstract
Leydig cell tumours (LCTs) are rare testicular stromal neoplasms classically presenting with a painless testicular mass or swelling in adults. Symptoms secondary to hypogonadism may occur resulting from the hormonal activity of these tumours. Loss of libido is described in LCTs in conjunction with other symptoms; however, no case has reported this as the sole presenting feature. We describe the case of a 42-year-old man presenting to his General Practitioner with loss of libido and no other features suspicious of testicular cancer. Ultrasound performed due to an unrelated epididymal cyst detected an incidental mass confirmed as a benign LCT following radical orchidectomy. Biochemical markers remained normal throughout and following treatment his libido returned to normal. This case may serve as a reminder for clinicians to maintain a high index of suspicion for testicular neoplasms in patients with features of hypogonadism in the absence of classical features for testicular cancer.
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Affiliation(s)
- Dominic Brown
- Urology Department, Princess Alexandra Hospital Trust, Harlow CM20 1QX, UK
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Ben Kridis W, Lajnef M, Khmiri S, Boudawara O, Slimen MH, Boudawara T, Khanfir A. Testicular leydig cell tumor revealed by hydrocele. Urol Case Rep 2020; 35:101520. [PMID: 33318945 PMCID: PMC7725736 DOI: 10.1016/j.eucr.2020.101520] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 12/01/2020] [Indexed: 01/16/2023] Open
Abstract
Leydig cell tumor (LCT) is a rare testicular tumor with a low incidence accounting 3% of all testicule neoplasms. Due to its rarity, the natural history of LCT is poorly understood. Patients can present with atypical symptoms and endocrine disorders. The diagnosis of LCT is based on histological and immunohistochemical examination. We report a new case of leydig cell tumor in a 61-year-old man presenting with a left testis hydrocele. The patient underwent a left orchidectomy and the diagnosis of LCT was established. Even in front of a benign pathology such as hydrocele, exploration is necessary to detect any testicle tumor.
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Affiliation(s)
- Wala Ben Kridis
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Maissa Lajnef
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Souhir Khmiri
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Ons Boudawara
- Department of Pathology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Mourad Haj Slimen
- Department of Urology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Tahia Boudawara
- Department of Pathology, Habib Bourguiba Hospital University of Sfax, Tunisia
| | - Afef Khanfir
- Department of Medical Oncology, Habib Bourguiba Hospital University of Sfax, Tunisia
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Chimento A, De Luca A, Nocito MC, Avena P, La Padula D, Zavaglia L, Pezzi V. Role of GPER-Mediated Signaling in Testicular Functions and Tumorigenesis. Cells 2020; 9:cells9092115. [PMID: 32957524 PMCID: PMC7563107 DOI: 10.3390/cells9092115] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022] Open
Abstract
Estrogen signaling plays important roles in testicular functions and tumorigenesis. Fifteen years ago, it was discovered that a member of the G protein-coupled receptor family, GPR30, which binds also with high affinity to estradiol and is responsible, in part, for the rapid non-genomic actions of estrogens. GPR30, renamed as GPER, was detected in several tissues including germ cells (spermatogonia, spermatocytes, spermatids) and somatic cells (Sertoli and Leydig cells). In our previous review published in 2014, we summarized studies that evidenced a role of GPER signaling in mediating estrogen action during spermatogenesis and testis development. In addition, we evidenced that GPER seems to be involved in modulating estrogen-dependent testicular cancer cell growth; however, the effects on cell survival and proliferation depend on specific cell type. In this review, we update the knowledge obtained in the last years on GPER roles in regulating physiological functions of testicular cells and its involvement in neoplastic transformation of both germ and somatic cells. In particular, we will focus our attention on crosstalk among GPER signaling, classical estrogen receptors and other nuclear receptors involved in testis physiology regulation.
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Affiliation(s)
- Adele Chimento
- Correspondence: (A.C.); (V.P.); Tel.: +39-0984-493184 (A.C.); +39-0984-493148 (V.P.)
| | | | | | | | | | | | - Vincenzo Pezzi
- Correspondence: (A.C.); (V.P.); Tel.: +39-0984-493184 (A.C.); +39-0984-493148 (V.P.)
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Bilateral Leydig Cell Tumors in Klinefelter Patient: A Case Report. Urology 2020; 142:e29-e31. [PMID: 32305546 DOI: 10.1016/j.urology.2020.03.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 03/24/2020] [Accepted: 03/30/2020] [Indexed: 11/22/2022]
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Azizi M, Aydin AM, Cheriyan SK, Peyton CC, Montanarella M, Gilbert SM, Sexton WJ. Therapeutic strategies for uncommon testis cancer histologies: teratoma with malignant transformation and malignant testicular sex cord stromal tumors. Transl Androl Urol 2020; 9:S91-S103. [PMID: 32055490 DOI: 10.21037/tau.2019.09.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Testicular cancer is the most common solid malignancy in male adolescents and young adults, with germ cell derived seminomas and non-seminomas being by far the most common histologies. Teratoma with somatic-type malignancy is a rare chemo-resistant phenotype of testis cancer associated with poor prognosis in patients with advanced stage disease. Malignant gonadal-stromal tumors comprise 5% of testicular neoplasms and approximately 10% are malignant and considered chemo-radiation resistant. Prognostic factors and treatment strategies for these uncommon histologies are lacking.
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Affiliation(s)
- Mounsif Azizi
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Ahmet M Aydin
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Salim K Cheriyan
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Charles C Peyton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Matthew Montanarella
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Scott M Gilbert
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA.,Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
| | - Wade J Sexton
- Department of Genitourinary Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL, USA
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Antonio L, Albersen M, Billen J, Maleux G, Van Rompuy AS, Coremans P, Marcq P, Jørgensen N, Vanderschueren D. Testicular Vein Sampling Can Reveal Gonadotropin-Independent Unilateral Steroidogenesis Supporting Spermatogenesis. J Endocr Soc 2019; 3:1881-1886. [PMID: 31592497 PMCID: PMC6773433 DOI: 10.1210/js.2019-00180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 07/24/2019] [Indexed: 01/02/2023] Open
Abstract
Suppressed gonadotropins combined with high-normal serum testosterone concentrations in oligozoospermic men suggest either use of exogenous testosterone or presence of a testosterone-producing tumor. We describe the case of a 31-year-old man referred for primary infertility. Gonadotropins were undetectably low, but testosterone and estradiol were in the high-normal range. Semen analysis showed oligoasthenospermia. He denied using exogenous testosterone. Scrotal ultrasound showed microlithiasis and millimetric hypolucent lesions in the left testis but no intratesticular mass. Human chorionic gonadotropin was low. To investigate unilateral hormone secretion, selective testicular venous sampling was performed. Testosterone and estradiol were clearly higher on the left side than on the right (130 vs 26 nmol/L and 1388 vs 62 pmol/L, respectively), with a left spermatic vein–to-periphery gradient of 4.3 for testosterone and 13 for estradiol; there were no similar gradients on the right side. This finding confirms that all sex steroid secretion came from the left testis. The patient was therefore referred for left orchidectomy. Histopathology revealed multifocal seminoma, germ cell neoplasia in situ, and Leydig cell hyperplasia but no choriocarcinoma. However, gonadotrophin levels increased after orchidectomy, indicating that the source of gonadotropin-independent sex steroid secretion was removed. Testosterone and estradiol decreased to the mid-normal range. Sperm concentration improved. This report thus shows that endogenous testosterone secretion in one testicle supports spermatogenesis without measurable levels of gonadotropins. Selective testicular venous sampling is useful to identify the site of unilateral secretion when the clinical picture is inconclusive. However, histopathology could not reveal the factor that stimulated Leydig cell steroidogenesis.
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Affiliation(s)
- Leen Antonio
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium
| | - Maarten Albersen
- Department of Urology, University Hospitals Leuven, Leuven, Belgium
| | - Jaak Billen
- Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Geert Maleux
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | | | - Peter Coremans
- Department of Endocrinology, Algemeen Ziekenhuis Nikolaas, Sint-Niklaas, Belgium
| | - Philippe Marcq
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.,Department of Endocrinology, Ziekenhuis Maas en Kempen, Maaseik, Belgium
| | - Niels Jørgensen
- University Department of Growth and Reproduction, Rigshospitalet, Copenhagen, Denmark.,International Center for Research and Research Training in Endocrine Disruption of Male Reproduction and Child Health, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Dirk Vanderschueren
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.,Department of Chronic Diseases, Metabolism and Ageing, Laboratory of Clinical and Experimental Endocrinology, KU Leuven, Leuven, Belgium.,Department of Laboratory Medicine, University Hospitals Leuven, Leuven, Belgium
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Abstract
RATIONALE Testicular Leydig cell tumor (LCT) is a rare neoplasm. It commonly presents as a painless testicular mass with or without endocrine changes. Histological and immunohistochemical examination play important roles in differentiating LCT from testicular germ cell tumors. PATIENT CONCERNS We highlight the imaging phenotype, as well as the pathological findings of a case of LCT in a 62-year-old male. DIAGNOSES Preoperative noncontrast CT scan of the abdomen revealed a 7.0 × 6.4 × 5.3 cm oval mass with heterogeneous density, located in the right testis. Pelvic noncontrast MRI showed a heterogeneous mass on T1-weighted and T2-weighted images. The solid part of the tumor exhibited high signal on the diffusion-weighted imaging, and an obvious enhancement on the contrast-enhanced MR imaging. Ultrasonography examination demonstrated a large mixed echogenic space occupying lesion involving the whole right testis with multiple cystic areas and increased vascularity. This patient underwent radical orchiectomy. The pathologic diagnosis was LCT. INTERVENTIONS This patient underwent operative resection of the tumor. Due to the negative resection margins and absence of distant metastases, the patient did not receive additional radiotherapy or chemotherapy. OUTCOMES Four months after the surgery, the follow-up CT-scan did not reveal any local recurrence and distant metastases. LESSONS This case improves our ability to detect and diagnose LCT by summarizing its imaging characteristics as well as reviewing the literature. Additionally, we described the state-of-the-art management of the management of this rare tumor.
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Affiliation(s)
- Jianguo Zhu
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University
| | - Yun Luan
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Nanjing, China
| | - Haige Li
- Department of Radiology, the Second Affiliated Hospital of Nanjing Medical University
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