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I nternational J ournal of Universal Pharmacy and Bio Sciences 3(3): May-J une 2014
INTERNATIONAL JOURNAL OF UNIVERSAL
PHARMACY AND BIO SCIENCES
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Bio Sciences CASE REPORT !!!

LEYDIG CELL TUMOR OF TESTIS A CASE REPORT
Dr. R.Padmavathy*, Dr. R. Arunalatha, Dr. R.Sathyalakshmi, Dr.Devi.J, Dr.Deepa.R
Professor, Department of Pathology, Madras Medical College, Chennai.

KEYWORDS:

Leydig cell tumor, testis,
inhibin.
For Correspondence:
Dr. R. Padmavathy*
Address:
Professor, Department of
Pathology, Madras
Medical College, Chennai.
Email: drdeepa24@yahoo.com








ABSTRACT
Leydig cell tumor accounts for 3 % of testicular neoplasm with
20% occurring in children less than 10 years of age. Herein we
describe an uncommon case of 6 year old male child with
testicular enlargement for 1 month. The excised tumor was 3 cm
with tan yellow cut surface and compressed testis in one pole.
Microscopy revealed sheets of uniform round to polyhedral cells
with abundant eosinophilic cytoplasm and vesicular nuclei. There
was no association with precocious puberty or gynecomastia. This
case is presented for its rarity and unusual presentation.
25 | P a g e International Standard Serial Number (ISSN): 2319-8141
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INTRODUCTION:
Leydig cell tumor accounts for 3 % of testicular neoplasm with 2 age peaks . 80 % of the tumors
occur in adults and 20 % in children between 5 and 10 years of age . These tumors are hormonally
active Feminizing or virilizing
4
. Children usually present with isosexual pseudoprecocity
1,3
. Few
cases may present with gynecomastia
1,6
. Testicular mass is small in children when compared to adults
and affect either testis equally
5
. The tumors exhibit benign behavior in prepubertal patients
2
. Some
tumors may present as incidental finding on scrotal ultrasonogram for some other condition
4
. Most
of the tumors are yellow tan intratesticular nodules with hemorrhage and necrosis. Microscopy reveals
solid , sheet like or pseudoglandular pattern with round or polygonal cells, abundant eosinophilic
cytoplasm and intracytoplasmic reinke crystalloids In 40 % of cases. Inhibin is positive in all cases.
Melan A and calretinin is seen in few cases. Vimentin is positive and CK may be seen. Malignancy is
rare before puberty
2
.
CASE REPORT :
A 6 year old boy presented with testicular swelling for 2 months and clinical examination revealed left
testicular enlargement. There was no evidence of precocious puberty or gynecomastia. Patient
underwent left orchidectomy and left testis measuring 4cm with attached cord was received. C/ s
revealed yellow nodule 3 cm in size Microscopic examination showed infantile testis in one pole
with a neoplasm composed of sheets, trabeculae and lobules of round to polyhedral cells with
abundant eosinophilic cytoplasm and uniform vesicular nuclei. It was a circumscribed neoplasm with
fibrous pseudo capsule. Immuno histochemistry was done for inhibit which showed diffuse intra
cytoplasmic positivity.
DISCUSSION :
Leydig cell tumors account for about 3 % of testicular tumors
1
and usually present with sexual
precocity
1,3
in children. Gynecomastia is due to production of estrogen by leydig cells
7
. It has 2 peaks
of age . Malignancy is rare in children
2
. In our case no sexual precocity was found and patient had
testicular enlargement. There was no cryptorchidism
6
. To the best of our knowledge only few cases of
leydig cell tumors have been repoted in paediatric age group. Testis sparing procedures ( Enucleation
of mass alone ) are recommended in prepubertal age group and benign lesions
3, 4,8
.
Differential diagnosis includes 1) Leydig cell hyperplasia which may form nodules mimicking tumor
and is seen in atrophic / cryptorchid testis and klinefelter syndrome. The lesion in multifocal, bilateral
have fibrous bands and do not have reinke crystals. They do not form expansile masses .
Seminiferous tubules are spared and not destroyed. 2) Malakoplakia may resemble leydig cell tumor
and is characterized by an admixture of chronic inflammatory cells and cytoplasmic inclusions with
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intratubular eosinophilic histiocytes and calcification. 3) Patients with adrenogenital syndrome or
Nelsons syndrome may develop testicular nodules. 4) Large cell calcifying sertoli cell tumor is
associated with calcification and are bilateral, multifocal without reinke crystals.
CONCLUSION :
Leydig cell tumor is a benign neoplasm of sex cord stromal origin in the testis. This case is presented
for its rarity and for its rare clinical presentation (absence of hormonal manifestation in pediatric age
group ). Pathologists have to be familiar with the diagnostic histopathologic features,
immunohistochemical panel of this tumor, and its principal differential diagnoses to prevent tumor
misdiagnosis.
REFERENCES :
1. Kim, Insun M.D,Robert H.M.B; Scully, Robert.E.M.D, Leydig cell tumors of testis
Clinicopathologic analysis of40 cases and review of literature, American Journal of Surgical
Pathology , March 1985, Vol9, issue 3 .
2. John C Thomas, Jonathan H Ross, Robert Kay, Stromal Testis Tumors in Children Report
from Prepubertal tumor Registry, The Journal of Urology, vol166, issue 6,Dec 2001, pg 2338-
2340.
3. Henderson CG, Ahmed AA, Sesterhenn.I,Belman AB, Enucleation for prepubertal leydig cell
tumor J.Urol Aug 2006, vol 176, issue 2 , pg 703-705.
4. Edmund.S.Sabanegh Jr,M.D, Edward David Kim, M.D, Leydig cell tumors Medscape
reference.
5. Patricia Oliver, Judith Simoneau Roy M.D, Diane Francoeur, Herve Sartelet MD, Leydig cell
tumors in children Contrasting clinical, Hormonal, Anatomical and Molecular Characteristics
in boys and girls, Journal of Pediatrics Dec 2012.
6. Leydig cell tumors of testis - Anthony A. Caldamone MD, Varoujan Altebarmakian, MD,
Irwin N.Frank , M.D Leydig cell tumor Overview ( University of Maryland Medical Centre )
7. An In Depth Look at Leydig cell Tumor of Testis Osama M.Al Agha, MD and Constantine
A. Axiotis, MD, Archives of Pathology & Laboratory Medicine: February 2007, Vol. 131, No.
2, pp. 311-317.
8. Leydig cell Tumor Comparison of results of radical and testis sparing surgery in a single
center Wegner H.E.H, Dieckmann K.P, Herbst H, Andresen R, Miller K, Urol Int 1997; 59;
170-173


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Legends for figures :
Figure 1: Gross picture of the testis


Figure 2: high power picture of leydig cell tumor





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Figure 3 : high power picture of leydig cell tumor

Figure 4 : low power picture of leydig cell tumor

Figure 5 : inhibin positivity.