惡性睪丸間質細胞瘤 : 病例報告及文獻回顧

高偉鈞林才揚、黃冠華

台南永康奇美醫院外科部泌尿科

Malignant testicular Leydig cell tumor: A case report and literature review

Wei-Chun Kao, Chye-Yang Lim, Steven K. Huang

Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan

 

Introduction: Malignant Leydig cell tumor (LCT) is an exceptionally rare form of testicular neoplasm, comprising less than 1% of all testicular cancers. Unlike its benign counterparts, malignant LCTs have the potential for aggressive behavior, with metastatic involvement commonly affecting the inguinal lymph nodes as well as distant extranodal organs such as the liver, lungs, and bones. Historically, malignant LCT has been described as a rapidly progressive disease with poor prognosis.

Case presentation: A 40-year-old male with no known systemic diseases experienced intermittent left scrotal pain for four months, which worsened with fever. He initially sought care at a district hospital where suspected orchitis and epididymitis was diagnosed with antibiotics prescribed, which provided no relief. The patient then presented to our emergency department. Scrotal ultrasound revealed a 4.2 × 4.0 × 3.2 cm hypoechoic tumor with calcifications in the left testis, raising suspicion of malignancy. Further imaging with computed tomography (CT) confirmed the presence of a 5.6 × 3.9 cm left testicular tumor, along with enlarged lymph nodes in the left para-aortic region, suggesting nodal metastases. Laboratory investigations showed lactate dehydrogenase (LDH) at 218 U/L, beta-human chorionic gonadotropin (β-HCG) < 1.2 mIU/mL, and alpha-fetoprotein (AFP) at 1.2 ng/mL.

 

Based on these findings and the high suspicion of testicular cancer, a two-stage surgical intervention was discussed and agreed upon by the patient. The first stage involved a left radical orchiectomy, performed after preoperative semen analysis and sperm banking. Pathological examination of the excised testis revealed a malignant Leydig cell tumor, with immunohistochemical positivity for inhibin A and calretinin. The tumor was staged as pT2NXMXS0. Staging investigations, including a bone scan and chest CT, excluded distant metastases to the bone and lungs. One month later, the patient underwent a planned second-stage retroperitoneal laparoscopic lymph node dissection. Pathology of the dissected lymph nodes revealed features of lymphoid hyperplasia without evidence of malignancy. Postoperatively, the patient was placed under surveillance without adjuvant chemotherapy. Tumor markers remained within normal limits, and follow-up pelvis CT performed six months later showed no evidence of local tumor recurrence. The patient continues to be monitored in aspects of image and laboratory examination.

Conclusions: Accurate preoperative diagnosis remains challenging due to the lack of specific clinical criteria. Most cases require surgical intervention, typically orchiectomy, for definitive diagnosis. This case report highlights the imaging characteristics of malignant Leydig cell tumors on CT and ultrasonography. Furthermore, our findings underscore the importance of individualized management strategies, suggesting that surveillance may be a viable option following orchiectomy and lymph node dissection in select cases of malignant Leydig cell tumors. Continued long-term follow-up is essential to further refine management approaches and improve outcomes in this rare and challenging condition.


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    台灣泌尿科醫學會
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    2024-12-20 01:54:49
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    2024-12-20 01:55:11
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