Leydig Cell Tumor of the Testis

Leydig Cell Tumor of the Testis

Article
Men's Health
Sexual Health
+2
Contributed byKrish Tangella MD, MBAAug 14, 2023

What are the other Names for this Condition? (Also known as/Synonyms)

  • Leydig Cell Tumor of the Testicles
  • Testicular Leydig Cell Tumor 

What is Leydig Cell Tumor of the Testis? (Definition/Background Information)

  • Leydig Cell Tumors (LCTs) of the Testis are testicular tumors affecting the stromal cells of the testis. Stromal cells are the structural and hormone-producing cells of the testis. LCTs of the Testis are the most common testicular sex cord-stromal tumors
  • In a vast majority of cases, the Leydig Cell Testicular Tumors are benign in nature; almost all cases in children and about 90% of the cases in adults are benign. Malignant LCTs of the Testis are very rare and are only seen in adults (middle-aged and older)
  • The testes are the male reproductive organs, equivalent to the ovaries in women. They are housed in the scrotum; the sac-like structure in the groin. The testis have 2 main functions:
    • Male hormone production
    • Sperm production
  • There are two types of cells in the testis:
    • Germ cells, which give rise to sperms
    • Stromal cells, which lend support to the testis and have hormone-producing ability
  • There are two main types of stromal cells:
    • Leydig cells: They make the sex hormones, mainly testosterone and also estrogen
    • Sertoli cells: They support the germ cells as they make sperms
  • Testicular cancer is cancer of the testicle, or testis. It is the most common form of cancer in young men aged 15-35 years. It is generally aggressive, but treatable when identified early
  • Stromal tumors make up 5-10% of the testicular cancers. Moreover, they comprise up to 20% of the testicular cancers in children
  • Stromal cell tumor cells may be mixed with germ cell tumor cells. Stromal cell cancers are not as dangerous as germ cell cancers, because they are not as likely to spread or metastasize
  • The cause of Leydig Cell Tumor of the Testis (a testicular cancer type) is generally unknown, although several risk factors, such as family history, weak immunity, or atrophy of testicles, are identified
  • The treatment and prognosis of Testicular Leydig Cell Tumors depend on whether it is a benign or malignant tumor. The benign tumors have excellent outcomes with adequate treatment, whereas the prognosis of malignant tumors depends on several factors including the stage of the tumor and overall health of the patient

Who gets Leydig Cell Tumor of the Testis? (Age and Sex Distribution)

In between 1-3% of all testicular tumors are Leydig Cell Tumors of the Testis.

  • Children, young boys, are at risk for benign LCTs of the Testis (malignant LCTs are not observed in them)
  • Adult males, especially those between the ages of 30-60 years, are at risk for both benign and malignant tumors. However, only about 10% of the Testicular Leydig Cell Tumors are malignant in adults
  • Caucasians are at a higher risk for these tumors

What are the Risk Factors for Leydig Cell Tumor of the Testis? (Predisposing Factors)

Following are factors that increase one’s susceptibility to Leydig Cell Tumor of the Testis:

  • Family history of testicular cancer
  • Caucasian descent
  • Decreased immunity, especially due to HIV/AIDS
  • Kidney transplant
  • Presence of carcinoma in situ (CIS), or intra-tubular germ cell neoplasia
  • Hypospadias (male birth defect affecting the urethra)
  • Inguinal hernia
  • Testicular atrophy
  • Gonadal dysgenesis
  • Infertility
  • Smoking
  • Exposure to radiation and industrial chemicals
  • Chemotherapy
  • Viruses (in some rare cases)

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider. 

What are the Causes of Leydig Cell Tumor of the Testis? (Etiology)

The cause of Leydig Cell Tumor of the Testis is unknown.

  • It is believed that abnormal differentiation of germ cells gives rise to cancerous cells that lead to the formation of this condition
  • However, how this occurs and the factors that cause it remain under investigation

What are the Signs and Symptoms of Leydig Cell Tumor of the Testis?

The signs and symptoms of Leydig Cell Tumor of the Testis depend on whether it is a benign or malignant tumor. The signs and symptoms may include:

  • Loss of libido
  • Overdevelopment of breasts in males (gynecomastia)
  • Breast pain, especially if accompanied by enlargement
  • Trouble breathing
  • Headache
  • Low blood pressure
  • Anemia
  • Testicular pain, lump in the testes, feeling of heaviness in the scrotum
  • Abdominal pain and swelling
  • Back pain
  • Swelling of the legs
  • Constipation
  • Changes in appetite
  • Fatigue
  • Frequent urination
  • Paralysis

How is Leydig Cell Tumor of the Testis Diagnosed?

Following are techniques that aid in identifying Leydig Cell Tumor of the Testis:

  • Physical examination to detect lumps in the testicles, which do not allow light to pass through
  • Tissue biopsy followed by microscopic analysis and staining
  • Blood tests that include:
    • Complete blood cell count (CBC) blood test
    • Liver function blood test (LFT)
    • Serum tumor marker blood test to detect increases in human chorionic gonadotropin (hCG)
    • Alpha-fetoprotein (AFP) blood test
    • Lactate dehydrogenase (LDH) blood test
    • Testosterone levels blood test
  • Genetic testing to determine mutations associated with Testicular Leydig Cell Tumor
  • Radiological imaging including:
    • X-Ray of the chest, abdomen, and pelvis
    • Ultrasound of the pelvis       
    • Computerized tomography (CT) scan of the brain
    • Vascular radiological studies
    • Whole body bone scan
    • Positron emission tomography (PET) scan

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis. 

What are the possible Complications of Leydig Cell Tumor of the Testis?

Following are complications that may arise from Leydig Cell Tumor of the Testis:

  • Infertility
  • Retrograde ejaculation
  • Excessive blood loss
  • In case of malignant tumors, metastasis and the loss of function of the organ/area to which the cancer spreads
  • Recurrence following the surgical removal of the tumor

How is Leydig Cell Tumor of the Testis Treated?

Treatments for Leydig Cell Tumor of the Testis depend on whether it is a benign or malignant tumor and may include the following procedures:

  • Removal of the original tumor and the metastatic tumors
  • Removal of the testis
  • Debulking surgery to reduce tumor size, followed by chemotherapy
  • Clotting the vessels in the tumor (embolization)
  • Chemotherapy
  • Radiotherapy
  • Undertaking treatment of underlying conditions

How can Leydig Cell Tumor of the Testis be Prevented?

In some cases, Leydig Cell Tumor of the Testis may be avoided through the following measures:

  • Monthly testicular self-examination
  • Genetic testing in individuals with a family history
  • Limiting exposure to radiation and industrial chemicals
  • Limiting chemotherapy
  • Not smoking

What is the Prognosis of Leydig Cell Tumor of the Testis? (Outcomes/Resolutions)

The prognosis of Leydig Cell Tumor of the Testis depends upon the severity of the signs and symptoms. It also depends upon the overall health of the individual and response to therapy.

  • Typically, in a vast majority of cases, the prognosis is excellent, since it is usually a benign tumor
  • In rare case of a malignancy, the prognosis may depend upon several factors including the stage of the tumor and health status of the individual
  • Generally, the following factors determine the prognosis of the condition:
    • Size of the tumor
    • Stage of the tumor     
    • Age of the individual
    • Overall health of the individual
    • Tumor location in the testes
    • Number of tumor masses present within the testes

Additional and Relevant Useful Information for Leydig Cell Tumor of the Testis:

  • Testicular cancers are aggressive in nature; they are also very quick to develop. Nonetheless, they are readily treatable
  • Testicular cancer is the most common form of cancer in US men aged 15 to 35 years. However, it is still relatively uncommon, with 5,500 cases in the US each year and 0.2-10.3 cases worldwide per 100,000 persons
  • In a study of 20 individuals aged 5-61 years with Leydig Cell Tumor of the Testis, who had undergone moderate surgery; all were cured and alive 15 years later
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Krish Tangella MD, MBA picture
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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