Leydig Cell Tumour of Testis and Scrotal Contents: A Review and Update
Authors: Kodzo-Grey Venyo Anthony 
Published: July 2024

It has been iterated that even though testicular cancers are relatively uncommon, and they account for only 1% to 2% of global male cancer diagnoses, it is the commonest malignancy in men who are aged between 15 years and 44 years. It has also been iterated that testicular tumours may originate from any of the cell types that are present within the testes and the on the whole fall into the two competing categories of germ cell tumours, of which approximately 95% of testicular cancer is comprised of, and sex cord-stromal tumours which constitute the remaining 5% of testis tumours in in adults. Out of the 5% of sex cord-stromal tumours, Leydig cell tumours are regarded to be commonest tumour which is derived from the same Leydig cells which normally reside within the interstitium of testis and secrete testosterone in the presence of luteinizing hormone. Leydig cell tumours of the testis are generally known to be benign tumours and only 5% to 10% being of Leydig Cell Tumours of the testis are considered to be malignant or portend malignant features. Leydig Cell Tumours of the testis have a bimodal distribution with peaks in the prepubertal age group and between the ages of 30 to 60. Apart from this Leydig Cell Tumours of the testis, had been reported in all age groups of males including young males and the over 90-yearl old male individuals sporadically. Due to Leydig cells' hormonally active properties, Leydig Cell Tumours might manifest with precocious puberty, breast tenderness, or gynecomastia, as well as infertility problems. Leydig cell tumours are derived from Leydig cells, which are histologically packed between the seminiferous tubules of the testis and they are physiologically responsible for testosterone secretion in response to luteinizing hormone. Apart from Leydig cell tumour afflicting the testis or rare occasions, Leydig Cell Tumour may also on very rare occasions afflict the epididymis. Leydig Cell Tumour of testis may manifest in different ways including: painless mass in the testis or intra-scrotal mass, precocious puberty, including early development of pubic hair as well as penile and musculoskeletal growth beyond that expected for the child’s age. Diagnosis of Leydig Cell Tumour of Testis whether benign or malignant is made based upon the histopathology examination and immunohistochemistry staining features of the tumour. Traditionally, Leydig cell tumours of the testis had been treated by the undertaking of radical orchidectomy based upon the provisional diagnosis of a malignant tumour only to find that the pathology examination of the orchidectomy specimen has confirmed features of Leydig Cell tumour of the testis which most often is benign. Radical orchidectomy alone has generally been curative for clinically benign Leydig cell tumours of testis. Testis-sparing surgery could be considered if the clinical suspicion of Leydig cell tumour is high, and pre-operative testicular serum tumour marker levels are within normal limits, and the size of the tumour is less than 2.5 cm. An intra-operative frozen section should always be undertaken to confirm benign Leydig Cell tumour of the tests, and a radical orchiectomy undertaken if the tumour is reported to be malignant. Leydig cell tumours of testis, do depict malignancy by metastasizing. About 10% of Leydig cell tumours in adults exhibit malignant biological behaviour. The only treatment for malignant Leydig cell tumour of testis is retroperitoneal lymph node dissection, in addition to the undertaking of radical orchidectomy due to the fact that they are known to be resistant to chemotherapy and radiotherapy. Because of the possibility of local recurrence of Leydig Cell Tumour of Testis, it is important for clinicians to ensure their patients undergo regular clinical and radiology imaging follow-up assessments for a long time.