Leydig cell tumours of the testis and variants

Epidemiology

Leydig cell tumours constitute 1-3% of all testicular tumours.

Clinical features

In children, they may present with isosexual pseudoprecocity. In adults, they present with a mass and/or gynaecomastia.

Histopathology

The usual appearance is of sheets of polygonal cells with abundant eosinophilic cytoplasm. they may be divided by hyalinised fibrous septa into lobules. Crystals of Reinke may be seen in 30-70% of cases. The presence of lipid may cause vacuolation.

Variants include:

Immunohistochemistry2

a-inhibin

15/163, 33/334, 28/285

Cytokeratins

Usually negative or weakly positive, some may show moderate / dot-like positivty2

Cam5.2

7/163

AE1/AE3

14/334

CK7

~50% of cases focally positive4

CK20

~50% of cases focally positive4

vimentin

14/163

S-100

10/163 , 2/264, 0/74

chromogranin

24/264, 3/74

synaptophysin

23/334

desmin

2/163

EMA

4/163

ER

some4

PR

some4

CD99

10/155

Melan-A

4/?46, 4/47

PLAP

4/155

CEA

0/163

Immunohistochemistry of variants1

 

Leydig cell tumour with adipose cells

Leydig cell tumour with spindle cells

 

usual component

fat component

usual component

spindle component

a-inhibin

6/7

5/7

4/5

3/5

Melan-A (A-103)

5/7

4/7

6/7

5/7

Calretinin

6/7

6/7

5/6

5/7

S-100

1/7

5/7

1/5

1/5

SMA

ND

ND

0/5

0/5

HHF-35

ND

ND

0/5

0/5

Differential diagnosis

Prognosis

References

1Ulbright, T. M., J. R. Srigley, et al. (2002). "Leydig cell tumors of the testis with unusual features: adipose differentiation, calcification with ossification, and spindle-shaped tumor cells." Am J Surg Pathol 26(11): 1424-33.

2Shanks JH, Iczkowski KA. Non-germ cell tumours of the testis. Current Diagnostic Pathology 2002;8:83-93.

3McCluggage, W. G., Shanks, J. H., Whiteside, C., Maxwell, P., Banerjee, S. S., Biggart, J. D. Immunohistochemical study of testicular sex cord-stromal tumors, including staining with anti-inhibin antibody. Am J Surg Pathol 1998;22:615.

4Iczkowski, K. A., Bostwick, D. G., Roche, P. C., Cheville, J. C. Inhibin A is a sensitive and specific marker for testicular sex cord- stromal tumors. Mod Pathol 1998;11:774.

5Kommoss, F., Oliva, E., Bittinger, F., Kirkpatrick, C. J., Amin, M. B., Bhan, A. K., Young, R. H., Scully, R. E. Inhibin-alpha CD99, HEA125, PLAP, and chromogranin immunoreactivity in testicular neoplasms and the androgen insensitivity syndrome. Hum Pathol 2000;31:1055-61.

6Busam, K. J., Iversen, K., Coplan, K. A., Old, L. J., Stockert, E., Chen, Y. T., McGregor, D., Jungbluth, A. Immunoreactivity for A103, an antibody to melan-A (Mart-1), in adrenocortical and other steroid tumors. Am J Surg Pathol 1998;22:57-63.

7Kaufmann, O., Koch, S., Burghardt, J., Audring, H., Dietel, M. Tyrosinase, melan-A, and KBA62 as markers for the immunohistochemical identification of metastatic amelanotic melanomas on paraffin sections Mod Pathol 1998;11:740-6.

This page last revised 30.11.2002.

©SMUHT/PW Bishop