METASTATIC LEYDIG-CELL TUMORS OF THE TESTIS - REPORT OF 4 CASES AND REVIEW OF THE LITERATURE

Leydig cell tumours constitute 1-2% of all testicular cancers and only 10% of patients with Leydig cell tumours will develop metastatic disease. They are considered refractory to chemo- and radiotherapy. The management of metastatic disease and the effects of systemic therapy have only been described in case reports. We report on four patients with metastic Leydig cell tumours, one of which was accompanied with excess sex hormone production. One patient was rendered tumour free by the surgical resection of retroperitoneal lymph nodes. and remains without recurrence for 10+ months. The other three patients received systemic treatment due to inoperable metastatic disease. One patient with progressive abdominal and supraclavicular lymph node metastases achieved a minor remission after 4 cycles of cisplatin-based chemotherapy, lasting for ten months. A second response to carboplatin-based chemotherapy was achieved in this patient at progression. The other two patients died 9 and 21 months after diagnosis of metastatic disease and never responded to chemotherapy. A review of the different treatment options for metastatic Leydig cell tumours is given. Surgery, which might include the resection of retroperitoneal lymph nodes or solitary pulmonary metastases, seems to be the only curative modality. Radiotherapy has apparently no effect and responses to systemic chemo- or hormonal therapy are infrequent and usually of short duration.