Sertoli cell tumour of testis, NOS

Clinical features

Mean age of presentation is 45 years. Usually present with a mass. Gynaecomastia is rare. Almost all cases are unilateral.

Macroscopic appearances

The tumour is usually well circumscribed and pale. There may be cyst formation.

Histopathology

The typical pattern is of hollow or slid tubules within a fibrous / hyalinised stroma. Ectatic blood vessels are common. Nuclei may be grooved, as seen in granulosa cell tumours. Cytoplasm is pale, eosinophilic or vacuolated.

Variant:

sclerosing Sertoli cell tumour: this has a prominent hyalinised stroma
seminoma-like

Immunohistochemistry

inhibin	10/111, 6/202
AE1/3	7/111
chromogranin	9/111
synaptophysin	5/111
S-100	7/111
CD99	1/72
EMA	negative3
CEA	negative3
PLAP	negative3

Differential diagnosis

Sertoli cell nodule (Pick's adenoma); associated with cryptorchidism and testicualr feminisation.
Sertoli-Leydig cell tumour; very rare, have a more cellular stroma
Large cell calcifying Sertoli cell tumour; associated with Carney's syndrome
Juvenile granulosa cell tumour; form follicules rather than tubules
Seminoma-like must be differentiated from a true seminoma
Cystadenoma of rete testis; confined to rete testis
Adenomatoid tumour; paratesticular
Carcinoid; strong chromogranin and synaptophysin positivty. May be associated with teratomatous element.
Metastatic adenocarcinoma; EMA positive
Sclerosing Sertoli cell tumour: metastatic adenocarcinoma of prostate; PSA positive
Metastatic melanoma: positive for more specific markers such as HMB-45.

Prognosis

About 12% of cases are malignant. Features associated with malignancy are3:

- large size (>5 cm)
- vascular invasion
- marked nuclear pleomorphism
- tumour necrosis
- mitotic index >5/10HPF

Sclerosing Sertoli cell tumours appear to be benign.

References

1Iczkowski, K. A., Bostwick, D. G., Roche, P. C., Cheville, J. C. Inhibin A is a sensitive and specific marker for testicular sex cord- stromal tumors. Mod Pathol 1998;11:774.

2Kommoss, F., Oliva, E., Bittinger, F., Kirkpatrick, C. J., Amin, M. B., Bhan, A. K., Young, R. H., Scully, R. E. Inhibin-alpha CD99, HEA125, PLAP, and chromogranin immunoreactivity in testicular neoplasms and the androgen insensitivity syndrome. Hum Pathol 2000;31:1055-61.

3Shanks JH, Iczkowski KA. Non-germ cell tumours of the testis. Current Diagnostic Pathology 2002;8:83-93.

This page last revised 2.12.2002.