High Frequency of Metastatic Leydig Cell Testicular Tumours

Farkas, László; Szekely, J.; Pusztai, Csaba; Baki, M.

doi:10.1159/000012147

Cited by 58 publications

(39 citation statements)

References 6 publications

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“…3,16 Conversely, the minority of patients that do present with metastatic disease have a poor prognosis. 7,8,17 In our series, patients with metastatic SCST at presentation have a two-year CSS of 30%, compared to a two-year CSS of 95% in those presenting with stage I disease. We present the first population-based analysis and largest published series to date characterizing this malignancy.…”

Section: Discussionmentioning

confidence: 56%

“…The prognosis for these individuals is poor. 7,8 Prior published series have reported the incidence of metastatic disease to be approximately 10%. The most common site of metastasis is to the retroperitoneum -similar to testicular germ cell tumours.…”

Section: Introductionmentioning

confidence: 99%

“…Some "centres of excellence" support testes-sparing surgery in small tumours, while other centres routinely perform prophylactic retroperitoneal lymph node dissection (RPLND) after the initial radical orchiectomy. [4][5][6][7]11 Some centres have employed highrisk histological features in the orchiectomy specimen to riskstratify patients and identify those who may benefit most from RPLND, although none of these findings have been well validated. 8,[11][12][13][14] In addition, no data have been published to date regarding population-level characteristics of this malignancy.…”

Section: Introductionmentioning

confidence: 99%

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A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

Yuh¹,

Lara²,

Wagenaar³

et al. 2017

CUAJ

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Introduction: We aimed to characterize demographic distribution, patient outcomes, and prognostic features of testicular sex cord stromal tumours (SCST) using a large statewide database.Methods: Adult male patients diagnosed with SCST between 1988 and 2010 were identified within the California Cancer Registry (CCR). Baseline demographic variables and disease characteristics were reported. Primary outcome measures were cancer-specific survival (CSS) and overall survival (OS). Bivariate and multivariate Cox proportional hazards models were employed to identify predictors of survival.Results: A total of 67 patients with SCST were identified, of which 45 (67%) had Leydig cell and 19 (28%) had Sertoli cell tumours. Median age was 40 years and the majority of patients (84%) presentedwith localized disease. Following orchiectomy, nine patients (15%) underwent retroperitoneal lymph node dissection (RPLND), whereas 54 patients (80%) had no further treatment. With a median followup of 75 months, two-year OS and CSS was 91% and 95%, respectively, for those presenting with stage I disease. For those presenting with stage II disease, two-year OS and CSS was 30%. Predictors of worse OS included age >60 (hazard ratio [HR] 5.64; p<0.01) and metastatic disease (HR 8.56; p<0.01). Presentation with metastatic disease was the only variable associated with worse CSS (HR 13.36; p<0.01). Histology was not found to be a significant predictor of either CSS or OS.Conclusions: We present the largest reported series to date for this rare tumour and provide contemporary epidemiological and treatment data. The primary driver of prognosis in patients with SCSTis disease stage, emphasizing the importance of early detection and intervention.

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Section: Discussionmentioning

confidence: 56%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A contemporary population-based study of testicular sex cord stromal tumours: Presentation, treatment patterns, and predictors of outcome

Yuh¹,

Lara²,

Wagenaar³

et al. 2017

CUAJ

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“…Some support the prophylactic retro-peritoneal lymph node dissection even in patients with clinical stage I tumors (tumor confined to the testis) 4,5 . Radiotherapy and chemotherapy have proved to be ineffective.…”

Section: Discussionmentioning

confidence: 98%

“…The commonest metastatic sites are regional lymph nodes, lung, liver and bones. The metastatic varieties occur exclusively in adults 4 and are more common in older patients with an average age of more than 60 years 2 . A 20% occurrence of the metastatic disease at the time of diagnosis and a 40% metastatic involvement within 2 years 5 have been reported.…”

Section: Discussionmentioning

confidence: 99%

Testicular leydig cell tumor presenting as primary infertility

Markou

vale²,

Vadgama³

et al. 2002

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A 29-year old male and his wife presented with an 18 month history of primary infertility. History and initial investigations suggested no major female pathologic component but a semen analysis revealed azoospermia. There was no history of any sexual dysfunction and neither partner was receiving any medication. Clinical examination revealed normal secondary sexual characteristics. Both testicles were of normal consistency with a volume of approximately 15mls but a 4x2cm mass was palpable at the lower pole of the left testis. Laboratory investigations revealed: serum testosterone 37.1nmol/l (NV:10.0-38.0 nmol/l), LH<0.3U/L (NV:3.0-12.0 U/L), and FSH <0.1IU/L (NV:3.0-11.0 U/L). Serum b-HCG, aFP, LDH, oestradiol and inhibin levels were within the normal range. A repeated semen analysis confirmed azoospermia. Testicular ultrasound demonstrated a well-defined hypoechoic mass, measuring 31x23x17mm and containing several flecks of calcification, arising from the lower pole of the left testis. A left orchidectomy was performed. Macroscopical histopathological examination revealed a single firm dark brown nodule 2.8 cm in diameter arising from the lower pole of the testis. The tumor distended the capsule of the testis without extending through it. Microscopical examination was consistent with a Leydig cell tumor. Computerised tomography of the chest, abdomen and pelvis was normal. Six months later, laboratory investigations revealed a serum testosterone of 14.3 nmol/l, an LH of 5.4U/L and an FSH of 4.3U/L, respectively. A repeated semen analysis was normal: volume 1.8 ml(2-10 ml), count 124x10 6 (20-350x10 6 ), motility 80%(>60%), abnormal forms <15%(<15%). Three months later his wife was pregnant. In summary, our patient presented with azoospermia, secondary to a Leydig cell tumor, which was reversible after removal of the tumor. A 35-year old woman and her 29-year old husband were referred to our infertility clinic with an eighteen month history of primary infertility. The female partner had a regular 4/28day menstrual cycle. Her past medical history included a termination of pregnancy at 6 weeks, with another partner, ten years previously. Neither sexually transmitted diseases nor a history of pelvic inflammatory disease were reported. She had never had a surgical operation. She was on no medical treatment and she did not report any drug intake. She was a non-smoker and she reported no alcohol intake.

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