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Painless Testicular mass + Gynecomastia

8339 Views 4 Replies 4 Participants Last post by  Laurentiu
A combination that should alert us to the possibility of Leydig cell tumor where the interesting testicular tumor may also produce estrogen.
Another clue is the description of rod shaped crystals in the tumor cells cytoplasm (what's called the Reinke crystals).
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Leydig cell tumor

This tumor comes under different questions in the exams.

Besides what was said:

This is a testicular non -germ tumor.
It is benign
It is producing androgen
It is the couse of precocious puberty in boys.
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Also think about choriocarcinoma. .. .
Its also presents with gynaecomastia. . .

poor prognosis lung metastasis may leads to dyspnea

Leydig cell tumors :
Age group- 5-10 or 30-60
precocious puberty
due to excess testosterone secreted by the tumour
Immunohistochemical markers of Leydig cell tumours include inhibin-alpha, calretinin, and melan-A.
10% bilateral of which most is Benign, malignant only 10%.
Scrotal ultrasonography is typically performed to confirm the diagnosis.

Microscopically, these tumors are composed of large, closely packed cells with eosinophilic cytoplasm, bland nuclei, and small nucleoli (see image below). Reinke crystals are pale-staining, cylindrical, rectangular, or rhomboid inclusions that are pathognomonic for Leydig cell tumors and are found in up to 30% of patients with such tumors. Microscopic features such as necrosis, marked pleomorphism, lymphovascular invasion, increased mitotic activity, and DNA aneuploidy are more consistent with a malignant variant.

No known role exists for radiation therapy in malignant Leydig cell tumors.
Leydig cell tumors have been primarily managed with surgical extirpation using radical inguinal orchiectomy.
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