Leydig cell tumour of the testis: presentation, therapy, long-term follow-up and the role of organ-sparing surgery in a single-institution experience

To report our single-centre experience of patients with Leydig cell tumour (LCT) of the testis, which represents the most frequent interstitial neoplasm of the testis, and for which the natural history and therapy are debated. Between 1990 and 2006, 37 patients were treated for LCT of the testis. All patients had testicular markers assessed and 21 (57%) had their hormonal profile assessed (total testosterone, follicle-stimulating hormone, luteinizing hormone and oestradiol). We analysed the symptoms at presentation, laboratory findings, organ-sparing vs. radical surgery and oncological and symptomatic follow-up data. Medical referral was for a testicular mass in 32% of patients, gynaecomastia in 8%, testicular pain in 8%, infertility in 11%, and isosexual pseudo-puberty in 5%. The mean (range) diameter of the tumour was 16.5 (6-68) mm. Before surgery testosterone levels exceeded the upper limit in a third of patients, while levels were hypogonadal in 19%. Oestradiol levels were increased in 29% of patients. At surgery, 29 patients (78%) had organ-sparing surgery. The median (range) follow-up was 4.6 (0.6-16.2) years; no patient had disease relapse. Gynaecomastia was present in two of six patients at the follow-up, despite pharmacological treatment. Four patients had a low testosterone level. Patients diagnosed with LCT have a good prognosis; this study shows the safety of conservative surgery. Surgical removal of the tumour is not always associated with resolution of symptoms and abnormal laboratory values.