Malignant LEYDIG-cell-tumours: Age as a risk-factor

Purpose: Approximately 8 percent of all testicular tumours are non-germ-cel l tumours. LEYDIG-cell-tumours, 10% of which are malignant, form a consider able part of these. The problem, however, is that there are no histo-pathol ogical criteria of the malignancy. The malignancy is only proven by the met astasation. On the basis of the tumours, which were observed here, a risk-f actor is worked out. Material and Methods: in the period from 1992 to 1997, 20 LEYDIG-cell-tumou rs in the Armed Forces Hospital Hamburg and in the General Hospital Harburg were treated. 4 of these patients had metastases. 1 patient had pulmonal a nd cerebral metastases, 1 patient had retroperitoneal and pulmonal metastas es, 2 patients had retroperitoneal and intraabdominal metastases. These 4 p atients have died. The clinical parameters such as tumour-size, gynaecomast ia and parameters of fertility were compared. The levels and the kinetics o f the parameters Estradiol, Testosteron, LH, FSH were reevaluated using sta tistical methods. Results: No significant difference between metastasized and non-metastasize d tumours regarding the clinical parameters and the laboratory-findings cou ld be found. A significant difference, however, emerged with regard to age at the time of the illness. The metastasized patients were between 42 and 6 6 years old (median 45 years) and the non-metastasized between 22 and 51 ye ars (median 29 years). This difference is significant mathematically (p=0.0 02). Conclusion: The path of metastasation of the LEYDIG-cell-tumours resembles that of germ-cell-tumours. Since there is no cure by chemotherapy or by rad iation, the only chance is that of radical surgery. Should each LEYDIG-cell -tumour be referred to retroperitoneal lymph node dissection (RPLND)? On th e basis of the potential introduced here, we think, that RPLND for all pati ents with LNDIG-cell-tumours, who are older than 40 years, must be offered. Whether the eradication of the last tumor-cell will be successful, is an o pen question.