Testis and epididymis
Nonneoplastic lesions
Sertoli cell hyperplasia

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

Revised: 11 April 2017, last major update October 2013

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PubMed Search: sertoli cell hyperplasia

Cite this page: Sertoli cell hyperplasia. PathologyOutlines.com website. http://pathologyoutlines.com/topic/testissertolihyperplasia.html. Accessed August 19th, 2017.
Definition / general
  • Nonneoplastic proliferation of Sertoli cells within seminiferous tubules, without any identifiable germ cells
Terminology
Epidemiology
Pathophysiology
  • Associated with McCune-Albright, Peutz-Jeghers and Androgen insensitivity syndromes but no molecular cause has been identified
Clinical features
  • Usually incidental finding in enlarged testis excised for suspicion of malignancy or orchidectomy performed in patient with Androgen Insensitivity Syndrome or cryptorchidism
  • Androgen insensitivity syndrome: phenotypically female
  • Peutz-Jeghers syndrome: multiple testicular nodules; may have gynecomastia and other signs of estradiol excess
Laboratory
  • Commonly elevated serum estradiol, low androgen levels
  • Serum levels of anti-Müllerian hormone and inhibin B may be elevated in some cases and can be used to monitor the evolution of this lesion
  • Serum AFP, β HCG and LDH are not elevated and are useful negative biomarkers to rule out germ cell tumors, which are more common
Prognostic factors
  • Most cases are nonneoplastic, with no potential for malignant transformation or metastases; prognosis is based on associated condition
  • Isolated case reports of development of Intratubular Large cell Sertoli cell neoplasia within otherwise classical ISCP or an associated invasive Sertoli cell tumor but no reports of progression for up to 10 years, even without orchidectomy (Am J Surg Pathol 2001;25:1237)
Case reports
Treatment
  • Not needed (conservative approach), since nonneoplastic, and usually an incidental finding
Gross description
  • Sertoli cell nodules are usually microscopic but larger nodules may be identified grossly
  • Rarely Sertoli cell hyperplasia replaces entire testis
  • Presence of multiple nodules giving rise to a nodular testis has been reported with Peutz-Jeghers syndrome
Gross images

Images hosted on other servers:

Demarcated bulging pale yellowish nodules

Sharply demarcated yellowish white nodule

Microscopic (histologic) description
  • Unencapsulated nodules composed of Sertoli cells arranged in well formed tubules that vaguely resemble immature Sertoli cells
  • Bland hyperchromatic oval / round nuclei that are stratified with variable eosinophilic (hyaline) blob in lumen
  • Tubules have thickened basement membrane, which invaginates within lumen, so that basement membrane-like material appears to be within the lumen and may be mistaken for a Call-Exner body
  • No / rare germ cells admixed with immature Sertoli cells
  • Adjacent testis commonly shows atrophy with hypospermatogenesis or total absence of spermatogenesis
  • Usually clusters of Leydig cells between the tubules, at least focally; rarely Leydig cell hyperplasia (which confirms a nonneoplastic process)
Microscopic (histologic) images

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Small sclerotic tubules with thickened tunica propria

Sertoli cells with hyperchromatic nuclei

Sertoli cell nodule


Hyperplastic Sertoli cells

Sertoli cell nodule

Boundary with normal testis

Round to elongated nuclei

Thickened basement membrane


Atrophic seminiferous tubules

Persistent immature tubules

Hyalinization of basement membrane

Atrophic seminiferous tubules

Positive stains
Negative stains
Electron microscopy images

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Thickened multilamellar basement membranes

Hyaline core

Differential diagnosis
  • Gonadoblastoma
    • Nested arrangement of large atypical germ cells, similar to seminoma cells with small cells resembling immature Sertoli cells and granulosa cells
    • Associated with mixed gonadal dysgenesis
  • Large cell calcifying Sertoli cell tumor
    • Polygonal cells with abundant eosinophilic cytoplasm
    • Relatively large nuclei with prominent nucleoli
    • Myxoid to fibrous stroma with scattered, large, irregularly shaped islands of calcification
  • Sclerosing Sertoli cell tumor
    • Prominent collagenous background
    • May contain focal entrapped nonneoplastic tubules, lined by immature Sertoli cells and germ cells but is a focal finding
    • Sclerotic stroma and not an accumulation of basal membrane substance
  • Sertoli cell tumor NOS
    • Lacks fetal phenotype
    • No prominent internalized basement membrane component
    • May have interspersed germ cells, secondary to incorporation of nonneoplastic elements, typically at periphery
    • Occurs in clusters that usually lack intratubular arrangement