Leydig cell tumor of the testis: A clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors

John C. Cheville, Thomas J. Sebo, Donna J. Lager, David G. Bostwick, George M. Farrow

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Abstract

Leydig cell tumors of the testis are rare and account for a small proportion of testicular neoplasms. The objective of this study was to identify clinical and morphologic features predictive of metastasis in a large series of Leydig cell tumors, and to determine whether ploidy or proliferative activity were predictive of malignancy. Thirty cases of Leydig cell tumor of the testis (23 tumors that had not metastasized and 7 that had metastasized) were studied. Clinical history and follow-up were collected in all cases. The morphologic features examined included tumor size, mitotic index (mitotic figures/10 high-power fields), necrosis, angiolymphatic invasion, cell type, tumor-testicle interface, presence of extension beyond the testicular parenchyma, and presence of lipochrome and Reinke crystals. Most patients (93%) had a testicular mass. Patients with Leydig cell tumors that metastasized were diagnosed at a mean age of 62 years (range, 39-70 years) compared with 48 years (range, 9-79 years) in patients with nonmetastasizing tumors (p = 0.25). Leydig cell tumors that metastasized were significantly larger than nonmetastasizing tumors (mean, 4.7 versus 2.6 cm, respectively; p = 0.008), and had a significantly higher mitotic index (mean, 13.9 versus 1.9, respectively; p < 0.0001). Metastasizing Leydig cell tumors were significantly associated with atypical mitotic figures (p < 0.0001), nuclear variation (p = 0.0025), necrosis (p < 0.0001), angiolymphatic invasion (p = 0.009), infiltrative margins (p < 0.0001), high grade (p = 0.0004), and invasion into rete testis, epididymis, or tunica (p = 0.001) when compared with nonmetastasizing tumors. There was no significant difference between metastasizing and nonmetastasizing tumors in regard to cell type, lipochrome content, presence of Reinke crystals, or nuclear inclusions. All Leydig cell tumors that metastasized and 7 of 18 (38.9%) nonmetastasizing tumors were DNA aneuploid by static image analysis (p = 0.02). Metastasizing Leydig cell tumors had a significantly higher mean MIB- 1 activity of 18.6% (range, 5.8-33.6) compared with 1.2% (range, 0.04-8.2) in nonmetastasizing tumors (p = 0.001). In this study, the presence of cytologic atypia, necrosis, angiolymphatic invasion, increased mitotic activity, atypical mitotic figures, infiltrative margins, extension beyond the testicular parenchyma, DNA aneuploidy, and increased MIB-1 activity were significantly associated with metastatic behavior in Leydig cell tumors.

Original languageEnglish (US)
Pages (from-to)1361-1367
Number of pages7
JournalAmerican Journal of Surgical Pathology
Volume22
Issue number11
DOIs
StatePublished - Nov 1998

Fingerprint

Leydig Cell Tumor
Testis
DNA
Neoplasms
Mitotic Index
Necrosis
Aneuploidy
Rete Testis
Intranuclear Inclusion Bodies
Ploidies
Epididymis
Testicular Neoplasms

Keywords

  • DNA content
  • Image analysis
  • Leydig cell tumor
  • Metastasis
  • MIB-1
  • Testicle

ASJC Scopus subject areas

  • Anatomy
  • Pathology and Forensic Medicine

Cite this

Leydig cell tumor of the testis : A clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. / Cheville, John C.; Sebo, Thomas J.; Lager, Donna J.; Bostwick, David G.; Farrow, George M.

In: American Journal of Surgical Pathology, Vol. 22, No. 11, 11.1998, p. 1361-1367.

Research output: Contribution to journalArticle

Cheville, John C. ; Sebo, Thomas J. ; Lager, Donna J. ; Bostwick, David G. ; Farrow, George M. / Leydig cell tumor of the testis : A clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors. In: American Journal of Surgical Pathology. 1998 ; Vol. 22, No. 11. pp. 1361-1367.
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T2 - A clinicopathologic, DNA content, and MIB-1 comparison of nonmetastasizing and metastasizing tumors

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AU - Sebo, Thomas J.

AU - Lager, Donna J.

AU - Bostwick, David G.

AU - Farrow, George M.

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N2 - Leydig cell tumors of the testis are rare and account for a small proportion of testicular neoplasms. The objective of this study was to identify clinical and morphologic features predictive of metastasis in a large series of Leydig cell tumors, and to determine whether ploidy or proliferative activity were predictive of malignancy. Thirty cases of Leydig cell tumor of the testis (23 tumors that had not metastasized and 7 that had metastasized) were studied. Clinical history and follow-up were collected in all cases. The morphologic features examined included tumor size, mitotic index (mitotic figures/10 high-power fields), necrosis, angiolymphatic invasion, cell type, tumor-testicle interface, presence of extension beyond the testicular parenchyma, and presence of lipochrome and Reinke crystals. Most patients (93%) had a testicular mass. Patients with Leydig cell tumors that metastasized were diagnosed at a mean age of 62 years (range, 39-70 years) compared with 48 years (range, 9-79 years) in patients with nonmetastasizing tumors (p = 0.25). Leydig cell tumors that metastasized were significantly larger than nonmetastasizing tumors (mean, 4.7 versus 2.6 cm, respectively; p = 0.008), and had a significantly higher mitotic index (mean, 13.9 versus 1.9, respectively; p < 0.0001). Metastasizing Leydig cell tumors were significantly associated with atypical mitotic figures (p < 0.0001), nuclear variation (p = 0.0025), necrosis (p < 0.0001), angiolymphatic invasion (p = 0.009), infiltrative margins (p < 0.0001), high grade (p = 0.0004), and invasion into rete testis, epididymis, or tunica (p = 0.001) when compared with nonmetastasizing tumors. There was no significant difference between metastasizing and nonmetastasizing tumors in regard to cell type, lipochrome content, presence of Reinke crystals, or nuclear inclusions. All Leydig cell tumors that metastasized and 7 of 18 (38.9%) nonmetastasizing tumors were DNA aneuploid by static image analysis (p = 0.02). Metastasizing Leydig cell tumors had a significantly higher mean MIB- 1 activity of 18.6% (range, 5.8-33.6) compared with 1.2% (range, 0.04-8.2) in nonmetastasizing tumors (p = 0.001). In this study, the presence of cytologic atypia, necrosis, angiolymphatic invasion, increased mitotic activity, atypical mitotic figures, infiltrative margins, extension beyond the testicular parenchyma, DNA aneuploidy, and increased MIB-1 activity were significantly associated with metastatic behavior in Leydig cell tumors.

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KW - Image analysis

KW - Leydig cell tumor

KW - Metastasis

KW - MIB-1

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