Testis and epididymis
Sex cord stromal tumors
Sertoli cell tumor, NOS

Author: Swapnil U. Rane, M.D. (see Authors page)

Revised: 19 July 2017, last major update December 2013

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PubMed Search: Testis Sertoli cell tumor [title]

Cite this page: Sertoli cell tumor, NOS. PathologyOutlines.com website. http://pathologyoutlines.com/topic/testisSertoliNOS.html. Accessed August 19th, 2017.
Definition / general
  • Sex cord stromal tumor of testis composed of cells expressing, to a varying degree, features of fetal, prepubertal or adult Sertoli cells
Terminology
  • Also called androblastoma
Epidemiology
  • < 1% of testicular tumors
  • Occurs in normally descended testis
  • Mean age 45 years; exceptionally rare in men < age 20 years
  • Most cases are sporadic but cases in infants / children are usually part of Peutz-Jeghers, androgen insensitivity or Carney syndromes
Clinical features
  • Typically present with slowly enlarging testicular mass (J Urol 1980;124:757)
  • Usually lack hormone related symptoms (Am J Surg Pathol 1998;22:709) but may have hyperestinism symptoms if part of Peutz-Jeghers syndrome
  • Presence of bilateral testicular Leydig cell tumors requires exclusion of Peutz-Jeghers syndrome
Laboratory
  • No specific laboratory finding
  • Hyperestrinism is noted in syndromic cases
Radiology description
  • Ultrasound is usually hypoechoic but not specific and not helpful in distinguishing from germ cell tumors
  • However, large cell calcifying variant can often be distinguished on ultrasound
Prognostic factors
  • 12% of cases are malignant
  • Features associated with malignancy are large size ( > 5 cm) (range 2 - 18 cm), vascular invasion, marked nuclear pleomorphism, tumor necrosis, mitotic index > 5/10HPF (Current Diagnostic Pathology 2002;8:83)
Case reports
Treatment
  • Orchidectomy is treatment of choice; usually sufficient because most tumors are benign
  • Benefit of chemotherapy or radiotherapy is not well documented
Gross description
  • Spherical, lobulated, well circumscribed tumors
  • Mean 3.5 cm (Am J Surg Pathol 1998;22:709), range 1 - 20 cm
  • Cut surface usually homogenous tan yellow or greyish white
  • Areas of necrosis usually not evident
  • Hemorrhage may be seen
Gross images

Images hosted on other servers:

Tumor in lower pole

Microscopic (histologic) description
  • Tumor cells are typically arranged in solid or hollow tubules separated by basement membrane; also retiform, tubule - glandular patterns, solid sheets or nodules
    • Well developed or abortive tubules present in at least one focus
  • Cytoplasm is pale eosinophillic to vacuolated due to extensive lipid
  • Tumor cells are bland and uniformly round with oval, elongated nuclei; no prominent nucleoli, no nuclear grooves, no inclusions
  • Rarely mild nuclear atypia and pleomorphism
  • Intervening stroma is fibrous; variably cellular, hyalinized, edematous, containing dilated blood vessels
  • Minor dystrophic calcifications may be seen within the stroma which may occasionally be extensive
  • Typically no stromal inflammatory cells
  • Mitoses are uncommon and is usually < 5 mitoses per 10 high power fields
  • Increased mitoses ( > 5 per high power field) in ~15% of cases but by itself does not constitute malignancy
Microscopic (histologic) images

Images hosted on other servers:

Cystic area with tubules

Pseudoglandular pattern

Solid - cystic areas

Retiform pattern

Hyalinized blood vessels

Negative stains
Electron microscopy description
  • Cells interconnected by desmosomes; abundant smooth ER, lipid droplets
  • Charcot-Böttcher crystals, composed of filaments, are typical of Sertoli cells but are rarely seen
Differential diagnosis