Testis & paratestis

• Nonneoplastic proliferation of immature Sertoli cells within seminiferous tubules
• Included in the spectrum of testicular dysgenesis syndrome (Clin Endocrinol (Oxf) 2009;71:459, MacLennan: Urologic Surgical Pathology, 4th Edition, 2019)

• Identified in adults with
  • Cryptorchid testis (~60%)
  • Normal scrotal testes (~22%)
  • Occasionally in infertile testis
  • Adjacent to germ cell tumor (MacLennan: Urologic Surgical Pathology, 4th Edition, 2019)

• Primary testicular lesion
• Seen within the spectrum of testicular dysgenesis syndrome
• Proliferation of seminiferous tubules which are unable to undergo pubertal development
• Reference: Clin Endocrinol (Oxf) 2009;71:459

Contributed by Raman Danrad, M.D.

• Well circumscribed, white-tan to yellow-tan nodules
• Size ranges from microscopic to 5 mm; may reach up to 10 mm (referred to as macroscopic)
• Can be single or multiple
• Firm to gelatinous
• References: Am J Surg Pathol 2010;34:1874, Pathol Res Pract 2016;212:943, J Clin Pathol 2006;59:1223

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• Circumscribed, unencapsulated nodules, comprised of
  • Prepubertal sized seminiferous tubules
  • Profiles of tubules vary from round to oval to hourglass in shape
  • Lined by columnar to pseudostratified epithelium composed of Sertoli cells with elongated, hyperchromatic nuclei, 1 or more peripherally located nucleoli and scant cytoplasm
  • Tubules are devoid of lumina; however, may contain globular hyaline material deposits, due to invagination of the excess basal lamina produced by Sertoli cells
    • Sertoli cells can be arranged in a ring shaped manner around the hyaline material
    • Basal lamina (basement membrane) type material may undergo calcification
  • Isolated spermatogonia may be observed in some nodules
• Interstitium varies from scant to well collagenized
  • Leydig cells are usually absent or low in numbers
• References: MacLennan: Urologic Surgical Pathology, 4th Edition, 2019, Am J Surg Pathol 2010;34:1874, J Clin Pathol 2004;57:802

Contributed by Ritu Bhalla, M.D. and Jian-Hua Qiao, M.D.

• Immature Sertoli cells
  • Vimentin, D2-40, CK8, CK18, calretinin and inhibin (MacLennan: Urologic Surgical Pathology, 4th Edition, 2019, J Clin Pathol 2006;59:1223, Am J Surg Pathol 2010;34:1874)
• Occasional spermatogonia seen in some cases can be highlighted by
  • NY-ESO-1 (J Clin Pathol 2006;59:1223)
  • TSPY (Am J Surg Pathol 2010;34:1874)
• Basement membrane material
  • PAS
  • Type IV collagen (J Clin Pathol 2004;57:802)

Images hosted on other servers:

A 30 year old man presents for evaluation of a nonpainful right testicular firmness. Ultrasound imaging showed a hyperechogenic lesion and orchiectomy was performed to rule out testicular neoplasm. Gross examination reveals a well circumscribed, white-tan, firm nodule measuring 8 mm in its greatest dimension with microscopic appearance as shown in the images above. What additional intervention is necessary after diagnosis?

1. Chemotherapy
2. Contralateral orchiectomy
3. No additional intervention is necessary
4. Retroperitoneal lymph node dissection

C. No additional intervention is necessary. The image reflects a Sertoli cell nodule, referred by some studies as macroscopic, being identified grossly with a size of 8 mm. Answers A, B and D are incorrect because Sertoli cell nodule is a nonneoplastic proliferation of immature Sertoli cells with no reported malignant potential; hence, no other intervention is required after histologic diagnosis.

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Reference: Sertoli cell nodule

A 25 year old man presents for evaluation of left lower abdominal pain. Imaging reveals the location of the left testicle in the inguinal canal. Subsequent orchiectomy revealed an unremarkable cut surface. Microscopic findings showed multiple, well circumscribed nodules with the appearance as shown in the images above. Which of the following immunohistochemical stains is expected to be positive?

1. hCG
2. Inhibin
3. OCT 3/4
4. PLAP

B. Inhibin. Sertoli cell nodule is composed mainly of immature Sertoli cells and inhibin helps to highlight and confirm their presence. Answers C, D and A are incorrect because OCT 3/4, PLAP and hCG are negative in Sertoli cell nodule and are helpful to rule out the presence of germ cell neoplasms.

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Reference: Sertoli cell nodule

Which of the following is a common finding in Sertoli cell nodules?

1. Atypical mitoses
2. Globular hyaline material deposits
3. Nuclei in a syncytium
4. Numerous spermatogonia

B. Globular hyaline material deposits. Sertoli cells produce an excess of basal lamina that invaginates into the involved tubules. Answer D is incorrect because spermatogonia, when present, are scattered. Answer A is incorrect because typical mitoses are not a common finding of Sertoli cell nodules and are more common in malignant entities. Answer C is incorrect because nuclei in a syncytium (syncytiotrophoblasts) are usually seen in germ cell tumors and are not an expected finding in Sertoli cell nodules.

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Reference: Sertoli cell nodule