Zusammenfassung
Hintergrund
Hodentumoren, die nicht dem Keimepithel entstammen, sind selten und stellen eine diagnostische und therapeutische Herausforderung dar. Der Leydig-Zell-Tumor (LZT) ist ein seltener Stromatumor des Hodens.
Ziel der Arbeit
Diagnostik und Therapie des LZT werden dargestellt.
Methode
Es erfolgte eine Literaturrecherche in PubMed und Bewertung der aktuellen Leitlinien zum LZT. Die Auswahl der Artikel und Buchbeiträge erfolgte basierend auf der Relevanz für den Behandlungsalltag.
Ergebnisse
Die geringe Inzidenz des nicht dem Keimepithel, sondern dem Stroma entstammenden LZT erfordert ein standardisiertes Vorgehen, um relevante Differenzialdiagnosen zu erkennen, die Diagnostik und Therapie am aktuellen Wissensstand auszurichten und die Dignität abzuklären. Während > 90 % der LZT benigne sind und ihre Therapie lokal begrenzt ist, steht bei den malignen Verlaufsformen das radikale operative Vorgehen sowohl testikulär als auch in der Metastasenchirurgie im Vordergrund.
Schlussfolgerung
Die möglichst standardisierte Diagnostik und Therapie sowie eine prospektive systematische Erfassung der seltenen LZT ermöglicht eine weitergehende Analyse, um das Verständnis für die Tumorbiologie und die Anpassung der therapeutischen Richtlinien einschl. der Nachsorge zu verbessern.
Abstract
Background
Tumors of the testes not originating from germinal epithelium are a rare entity and represent a diagnostic and therapeutic challenge. Leydig cell tumors (LCT) are rare stromal tumors of the testis.
Objectives
To present current approaches in diagnostic and treatment of LCT.
Methods
A literature search in PubMed was performed and the currently available guidelines concerning LCT were evaluated. Articles and book chapters were selected based on relevance to daily practice.
Results
The low incidence of Leydig cell tumors not originating from the germinal epithelium, but from the stroma of the testis requires a standardized approach to determine relevant differential diagnosis and to optimize diagnosis and treatment depending on the current standard of knowledge and to determine whether it is benign or malignant. While more than 90% of LCT are benign and treatment is only restricted to the testis, malignant subtypes require radical surgical resection of the testicular and metastatic sites.
Conclusion
A standardized diagnostic and therapeutic approach as well as a prospective registry of rare LCT could facilitate further detailed analysis to improve the understanding of tumor biology resulting in optimized therapeutic guidelines including follow-up strategies.
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Kliesch, S. Diagnose und Therapie des Leydig-Zell-Tumors. Urologe 60, 880–885 (2021). https://doi.org/10.1007/s00120-021-01576-8
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DOI: https://doi.org/10.1007/s00120-021-01576-8