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Title: | Leydig cell hyperplasia in children: Case series and review. | Authors: | King S.K.;Marulaiah M.;Mennie N.;Ferguson P.;Heloury Y.;Kimber C. | Institution: | (Mennie, Marulaiah, Ferguson, Kimber) Department of Paediatric Surgery, Monash Children's Hospital, Melbourne, Australia (King) Department of Paediatric Surgery, The Royal Children's Hospital, Melbourne, Australia (King) Department of Paediatrics, University of Melbourne, Melbourne, Australia (King, Heloury) Surgical Research, Murdoch Children's Research Institute, Melbourne, Victoria, Australia (Heloury) Department of Urology, The Royal Children's Hospital, Melbourne, Australia | Issue Date: | 29-May-2017 | Copyright year: | 2017 | Publisher: | Elsevier Ltd | Place of publication: | United Kingdom | Publication information: | Journal of Pediatric Urology. 13 (2) (pp 158-163), 2017. Date of Publication: April 2017. | Journal: | Journal of Pediatric Urology | Abstract: | Introduction Leydig cell hyperplasia (LCH) and Leydig cell tumours (LCTs) in children are rare, typically presenting with precocious puberty. Previously, orchidectomy was the routine management; however, more recently, testis-sparing surgery has been performed with good results. We present a series of unusual presentations of LCH, raising new management questions, and a review of the literature regarding LCH and LCT in children. Study design We performed a literature search using Ovid Medline, PubMed, and Google Scholar, producing 456 articles. We reviewed all case reports and series containing paediatric patients, and relevant review articles. Results We report three cases of LCH, two of which were incidental findings. All three cases underwent testis-sparing surgery. In the literature there were seven cases of LCH and 101 cases of LCT in prepubertal children. The most common presentation was with precocious puberty. Three cases of LCH and more than two-thirds of LCTs were managed with orchidectomy and overall only 11% of the cases underwent testes-sparing surgery (24% did not specify operative management). There were no reports of recurrence or malignancy. Discussion Our case series presents three new clinical presentations of LCH that have not previously been reported in the literature: one of incomplete precocious puberty and two with incidental findings on ultrasound in asymptomatic children. Historically, children with the classic presentation of precocious puberty and a testicular lesion have been managed with orchidectomy. Nowadays, many clinicians advocate testes-sparing surgery given there have been no cases of malignancy. In children with no clinical or biochemical signs of precocious puberty, lesions identified on ultrasound can be safely monitored for a period of time. However, if the lesion does not regress, excisional biopsy is recommended to establish the diagnosis, ideally before the onset of puberty. Conclusion Leydig cell hyperplasia and tumours in pre-pubertal children are benign. Testes-sparing surgery with regular follow-up appears to be safe management.Copyright © 2017 Journal of Pediatric Urology Company | DOI: | http://monash.idm.oclc.org/login?url=http://dx.doi.org/10.1016/j.jpurol.2016.12.028 | ORCID: | Mennie, Nicole; ORCID: http://orcid.org/0000-0002-8980-3701 | Link to associated publication: | Click here for full text options | PubMed URL: | 28238607 [http://www.ncbi.nlm.nih.gov/pubmed/?term=28238607] | ISSN: | 1477-5131 | URI: | https://repository.monashhealth.org/monashhealthjspui/handle/1/38665 | Type: | Review | Subjects: | lymphadenopathy male orchiectomy precocious puberty preschool child priority journal review school child testicular enlargement testis biopsy testosterone blood level androstenedione/ec [Endogenous Compound] testosterone/ec [Endogenous Compound] *Leydig cell hyperplasia/et [Etiology] *Leydig cell hyperplasia/su [Surgery] pathophysiology androstenedione blood level case report *cell hyperplasia/et [Etiology] *cell hyperplasia/su [Surgery] child clinical examination clinical feature follow up frozen section hair growth hematoma histopathology human human tissue immunohistochemistry incidental finding incision inguinal pain incidental finding incision inguinal pain lymphadenopathy male orchiectomy pathophysiology precocious puberty preschool child priority journal Review school child clinical examination testis biopsy testosterone blood level child *cell hyperplasia / *etiology / *surgery case report androstenedione blood level testicular enlargement clinical feature follow up frozen section hair growth hematoma histopathology human human tissue immunohistochemistry |
Type of Clinical Study or Trial: | Case series or case report |
Appears in Collections: | Articles |
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