Conservative surgical therapy for leydig cell tumor.
OBJECTIVE
We performed a long-term evaluation of conservative surgical treatment of benign Leydig cell tumor.


METHODS
A multicenter retrospective clinical study was performed at 6 European centers. Case files of all patients diagnosed with Leydig cell tumor and treated with conservative surgery were examined. Patients underwent physical examination, hormone and tumor marker assays, scrotal and abdominal ultrasound, chest x-ray, and an endocrinological examination.


RESULTS
From 1987 to 2006, 22 patients with Leydig cell tumor underwent conservative surgery. Mean patient age was 35 years (range 5 to 61). Mean followup was 47 months (range 1 to 230). No local recurrence or metastasis was observed. Patients presented with a palpable testicular nodule (3 patients, 13.7%) or a nodule diagnosed by ultrasound (15 patients, 68.2%), gynecomastia (2 patients, 9.1%), precocious pseudopuberty (1 patient, 4.5%) or scrotal pain (1 patient, 4.5%). Three patients were monorchid after contralateral orchiectomy for inguinal hernia repair (1 patient, 28 years before surgery) and nonseminomatous germ cell tumor (2 patients, 1 month and 6 years before surgery). Diagnosis after frozen section examination was Leydig cell tumor in 20 of 22 cases (91.0%). Mean histological size of the nodule was 1.11 cm (range 0.5 to 2.5). Preoperative FSH and LH levels were high in 4 patients. Tumor markers were normal before and after surgery. Followup was conducted for all patients every 3 to 6 months with physical examination, tumor markers, scrotal and abdominal ultrasound, chest x-ray. Six patients (27.3%) underwent abdominal computerized tomography.


CONCLUSIONS
When diagnosed early Leydig cell tumors present a favorable followup. In select cases with motivated patients, conservative surgery proved to be a feasible and safe choice.
Carmignani
Luca
L
Urology Unit, Department of Medicine and Surgery, University of Milan, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy. luca.carmignani@unimi.it
Colombo
Renzo
R
Gadda
Franco
F
Galasso
Giacomo
G
Lania
Andrea
A
Palou
Juan
J
Algaba
Ferran
F
Villavicencio
Humberto
H
Colpi
Giovanni Maria
GM
Decobelli
Ottavio
O
Salvioni
Roberto
R
Pizzocaro
Giorgio
G
Rigatti
Patrizio
P
Rocco
Francesco
F
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D042241:Early Diagnosis; D006801:Humans; D007984:Leydig Cell Tumor / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009919:Orchiectomy; D012189:Retrospective Studies; D013736:Testicular Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D013737:Testis / Q000473:pathology / Q000601:surgery