Histologically, the testicular tumors in patients with CAH resemble LCTs, and differentiation can be difficult (see Fig. 3) (30). However, some differences may exist; testicular tumors associated with CAH are bilateral in 83% of the cases and LCTs are bilateral in only 3% of cases. Malignant degeneration has not been reported in testicular tumors associated with CAH, but it occurs in 10% of LCTs in adults (30). In addition, the tumors are located in the mediastinum testis and often decrease in size when ACTH levels are suppressed by increasing the glucocorticoid dose (11,28,31-34). Rich et al. (30) found that both the testicular tumors of CAH and LCTs are circumscribed, lobulated, nodular lesions. CAH tumors are typically encapsulated nodules that are dark brown (resulting from a greater concentration of lipochrome pigmentation), whereas LCTs are usually yellow intratesticular masses. The color distinction is not always reliable, however, because some LCTs are occasionally darker. Reinke's crystals, which can be found in 25-40% of LCTs, have never been observed in CAH tumors. In the surrounding parenchyma, seminiferous tubules show atrophic sclerosis in CAH tumors, whereas in LCTs seminiferous tubules are rarely found because they are replaced by the tumor (31).
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