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JPTM > Ahead-of Print

doi: https://doi.org/10.4132/jptm.2019.05.23    [Epub ahead of print]
Metastatic Leydig Cell Tumor: A Clinico-pathological Review of Five Cases
Mayank Gupta
Department of General Pathology, Christian Medical College, Vellore, India
Corresponding Author: Mayank Gupta ,Tel: +914162283125, Fax: +914162232035, Email: gupta.mayank103@gmail.com
Received: February 27, 2019;  Revised: May 23, 2019  Accepted: May 25, 2019.  Published online: July 16, 2019.

Although Leydig cell tumors (LCTs) account for only 1-3% of all testicular neoplasms, they are the most common sex cord-stromal tumor of the testis. LCT is most common in patients between 10 and 50 years of age, although they can present at any age. Most of them are clinically benign, but < 5% of tumors develop metastasis. This study analyzes the clinico-pathological features from five cases of metastatic LCTs.
Material and methods:
Routine sections of five cases of LCT were reviewed and the following immunohistochemical markers were assessed: cytokeratin, TTF-1 (thyroid transcription factor), oct3/4, PLAP (placental alkaline phosphatase), CD30, LCA (leukocyte common antigen), synaptophysin, chromogranin, alpha-inhibin, calretinin, CD56, melan-A and androgen receptor (AR). The clinical, biochemical and radiological details were retrieved from the patients’ medical records.
All five cases were adults who presented with a painless testicular mass. Two out of four cases had hemoptysis. On imaging, the adrenal glands were normal, and all cases had enlarged para-aortic nodes. One case had an enlarged left supraclavicular node without lung involvement, and the rest of the cases had metastatic lung nodules. All the cases were medically unfit for surgery, so the biopsies were taken from the metastatic sites. Histology and immunohistochemical expression of alpha-inhibin and AR confirmed the diagnosis of metastatic LCT. Although all the cases were given chemotherapy, none of them survived.
Metastatic LCTs are rare and have a poor prognosis. The clinico-radiological correlation with histomorphology and a specific immunohistochemical workup provide a definite diagnosis.
Key Words: Leydig cell tumor; Alpha-inhibin; Sertoli cell tumor