MP37-16 RISK FACTORS FOR MALIGNANCY IN PATIENTS WITH LEYDIG CELL TUMORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 1’375 PATIENTS

You have accessJournal of UrologySexual Function/Dysfunction: Penis/Testis/Urethra: Benign Disease & Malignant Disease I1 Apr 2018MP37-16 RISK FACTORS FOR MALIGNANCY IN PATIENTS WITH LEYDIG CELL TUMORS: A SYSTEMATIC REVIEW AND META-ANALYSIS OF 1’375 PATIENTS Christian Fankhauser, Josias Grogg, Peter Bode, Tullio Sulser, Joerg Beyer, and Thomas Hermanns Christian FankhauserChristian Fankhauser More articles by this author , Josias GroggJosias Grogg More articles by this author , Peter BodePeter Bode More articles by this author , Tullio SulserTullio Sulser More articles by this author , Joerg BeyerJoerg Beyer More articles by this author , and Thomas HermannsThomas Hermanns More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1222AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Most Leydig cell tumors (LCT) are considered benign tumors and patients with LCT are usually cured by surgical excision. However, in some patients LCT have malignant potential. Patients with metastatic LCT often die of their disease because standardized and effective treatment options are not available. Thus, early identification of malignancy is crucial to offer patients a risk-adapted therapy and to modify postoperative surveillance. Currently used risk factors for malignancy are based on a publication with only 30 patients (Kim et al. 1985). The aim of the present investigation was to identify risk-factors for LCT. METHODS We performed a systematic review through MEDLINE, EMBASE, Scopus, Cochrane Database of Systematic Reviews and Web of Science up to September 2015 to identify case reports and series describing patients with testicular LCT. Whenever feasible data was extracted on individual patient level. RESULTS After deduplication we screened 3274 publications by reading the title and the abstract. 796 publications were eligible for full text review. Finally, 357 publications including 67 retrospective cohort studies and 290 case reports described 1375 patients. Median age was 35 y (IQR 22). Metastases were found in 101 out of 1040 (10%) patients. At initial staging metastases were present in 30 patients (retroperitoneal lymph nodes (LN) (19), lung (15), liver (5), mediastinal LN (4), kidney (4) and brain (3)), while 65 patients developed metastases (retroperitoneal LN (35), liver (24), lung (23), bones (10) and inguinal LN (8)) after a median follow-up of 22 months (IQR 30). Patients with metastases had larger tumors (>5cm (82% vs 28%.; p<0.01), more mitoses (>3 mitosis per HPF; 84% vs 45%; p<0.01) and more often spermatic chord extension (60% vs. 26%, p=0.038), necrosis (77% vs. 19%, p<0.01), angiolymphatic invasion (73% vs 9% , p<0.01), a high mitotic index (71% vs. 23%, p<0.01), atypias (89%, vs 33% p<0.01) and pleomorphism (85% vs 50%), p=0.02). Reinke crystals (50% vs 14%, p<0.01), lipofuscin pigment (75% vs 20%, p=0.01) and gynecomastia (72% vs 30%, p<0.01) were more often found in patients with benign disease. CONCLUSIONS The current summary of the literature certainly overestimates the prevalence of malignant LCT due to publication bias. However, several easy-to-assess clinicopathological features can be helpful to predict malignancy of LCT. Regular follow-up including imaging of the abdomen and chest or even more aggressive initial treatment (e.g. retroperitoneal lymphadenectomy) should be considered in patients with one or more of these clinicopathological risk factors. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e497-e498 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Christian Fankhauser More articles by this author Josias Grogg More articles by this author Peter Bode More articles by this author Tullio Sulser More articles by this author Joerg Beyer More articles by this author Thomas Hermanns More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...