Bilateral Leydig cell tumors with unilateral cryptorchidism. Case report

One lump or two? Concomitant Leydig cell tumour and paratesticular leiomyoma in an adult man

We present the first reported case of a concomitant Leydig cell tumour (LCT) and paratesticular leiomyoma in an adult man with a history of bilateral cryptorchidism. An 80-year-old man presented with a 2-month history of a left testicular lump associated with mild discomfort and a gradual increase in size on a background of bilateral cryptorchidism requiring multiple orchidopexy procedures as a child. Ultrasound confirmed a lesion suspicious for malignancy and he proceeded to a left radical orchidectomy. Histopathological assessment of the left testis revealed a concomitant testicular LCT with rare malignant features and paratesticular leiomyoma.

Non-tumoural parenchyma in Leydig cell tumours: pathogenetic considerations

Little is known about the pathogenesis of Leydig cell tumours (LCTs) of the testis. The observation of several associated dysgenetic features in the non-tumoural parenchyma and in the contralateral testes of men with testicular germ cell neoplasms has served as the basis to propose that there may be a common mechanism for different male reproductive disorders. However, the possible relationship between LCTs and other testicular lesions has not been explored. Here we describe the presence of primary lesions in the non-tumoural parenchyma of testes with LCT, from which we try to establish possible pathogenetic associations. We studied the non-tumoural parenchyma adjacent to 16 LCT specimens. Parameters as Leydig cell hyperplasia (LCHY), qualitative evaluation of the germinal epithelium and spermatogenesis, the presence of Sertoli cell-only tubules (SCOT), and the Sertoli cell nuclear morphology were consistently assessed in all cases. SCOT associated with Sertoli cell dysgenetic morphology was the most frequent finding, present in 50% of the cases. Another interesting finding was the presence of LCHY in four cases (25%). Abnormal spermatogenesis was found in 81.25% of the cases, and it consisted of lesions of the adluminal or basal compartments of seminiferous tubules. The occurrence of either dysgenetic Sertoli cells or LCHY adjacent to LCTs could represent primary anomalies, resulting from a common insult also involved in tumourigenesis. The abnormalities in spermatogenesis observed here are likely to represent consequences of either tumour compression or abnormal hormonal production. The significance of these associations merits further investigation regarding a common pathogenesis.

Organ-sparing surgery for bilateral leydig cell tumor of the testis

Leydig cell tumors of the testis are uncommon, and bilateral lesions are extremely rare. We report a case of bilateral Leydig cell tumor of the testis treated with radical orchiectomy and contralateral subtotal orchiectomy with the intent of preservation of hormonal function and fertility.

Histological Findings in Cryptorchidism

Cryptorchidism is an anomaly in the migration of the testis. Although frequent (1% of the population), the causes are still not fully clear. The associated histological lesions are constant and are worse the longer the testis remains in an anomalous position and the higher this position. Alterations in the maturation of the germinal cells appear very early at about the 7th month of life, gradually becoming more severe until there is complete atrophy of the seminiferous tubules in post-puberty. With histological lesions in the cryptorchid testis there is a risk of seminomatous cancer developing in the undescended testis and of a mixed or non-seminomatous type in the descended testis. Orchiopexy does not reduce the risk of cancer in the cryptorchid testis, but it does eliminate the hyperthermic state in the gonad and allows a simpler, more reliable clinical and biopsy assessment of the testis after surgery.