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Presented by Dr. Jonathan Epstein and prepared by Dr. Sintawat Wangsiricharoen
A 20 year-old man underwent a radical orchiectomy for a 1.2 cm. testicular mass.
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Question 1 of 1
1. Question
A 20 year-old man underwent a radical orchiectomy for a 1.2 cm. testicular mass.
Choose the correct diagnosis:
Correct
Answer: A. Sex cord stromal tumor with fibrothecomatous and Sertoli components
Histological Description: There is a well-circumscribed nodule in the testis up against the tunica. It has a biphasic appearance. There are small tubules that are line by bland epithelium with round-oval nuclei that have uniform open chromatin with a single central small nucleolus. The 2nd component is formed by bland uniform spindle cells with eosinophilic cytoplasm and variable cellularity. Mitotic figures in both components are rare.
Discussion: The cytology seen in the tubules are identical to normal Sertoli cells. The spindle cell component is similar to what is seen in fibrothecomatous lesions more commonly found in the ovary. This case is unusual in that it is much more common to have either a pure Sertoli cell tumor or a pure testicular fibrothecoma as opposed to a tumor with both elements. Although testicular fibrothecomas can have worrisome histologic features such as minimal invasion into surrounding testis, high cellularity, and increased mitotic rate, they are uniformly benign in their behavior. The current case lacks any malignant features (i.e. >5 cm, vascular invasion, widespread local invasion, necrosis, pleomorphism, or increase mitotic figures) such that a benign diagnosis can be rendered. Fibrothecoma may closely resemble spindle cell lesions
seen outside of the testis, including monophasic synovial sarcoma or in this case biphasic synovial sarcoma. To our knowledge, synovial sarcoma has not been reported in the testis. Inhibin or SF-1 (steroid factor 1) immunoreactivity also helps define the sex cord stromal origin. In the current case, the glands have small indistinct nucleoli as opposed to more prominent nucleoli glands within a biphasic synovial sarcoma. A pitfall in the assessment of sex cord stromal tumors of the testis is that they can be negative immunohistochemically for inhibin, melan-a, and calretinin. A more sensitive marker for all sex cord stromal tumors that may not be as available to pathologists is SF-1.Reference:
Testicular fibrothecoma: a morphologic and immunohistochemical study of 16 cases. Zhang M, Kao CS, Ulbright TM, Epstein JI. Am J Surg Pathol. 2013; 37:1208-14.Incorrect
Answer: A. Sex cord stromal tumor with fibrothecomatous and Sertoli components
Histological Description: There is a well-circumscribed nodule in the testis up against the tunica. It has a biphasic appearance. There are small tubules that are line by bland epithelium with round-oval nuclei that have uniform open chromatin with a single central small nucleolus. The 2nd component is formed by bland uniform spindle cells with eosinophilic cytoplasm and variable cellularity. Mitotic figures in both components are rare.
Discussion: The cytology seen in the tubules are identical to normal Sertoli cells. The spindle cell component is similar to what is seen in fibrothecomatous lesions more commonly found in the ovary. This case is unusual in that it is much more common to have either a pure Sertoli cell tumor or a pure testicular fibrothecoma as opposed to a tumor with both elements. Although testicular fibrothecomas can have worrisome histologic features such as minimal invasion into surrounding testis, high cellularity, and increased mitotic rate, they are uniformly benign in their behavior. The current case lacks any malignant features (i.e. >5 cm, vascular invasion, widespread local invasion, necrosis, pleomorphism, or increase mitotic figures) such that a benign diagnosis can be rendered. Fibrothecoma may closely resemble spindle cell lesions
seen outside of the testis, including monophasic synovial sarcoma or in this case biphasic synovial sarcoma. To our knowledge, synovial sarcoma has not been reported in the testis. Inhibin or SF-1 (steroid factor 1) immunoreactivity also helps define the sex cord stromal origin. In the current case, the glands have small indistinct nucleoli as opposed to more prominent nucleoli glands within a biphasic synovial sarcoma. A pitfall in the assessment of sex cord stromal tumors of the testis is that they can be negative immunohistochemically for inhibin, melan-a, and calretinin. A more sensitive marker for all sex cord stromal tumors that may not be as available to pathologists is SF-1.Reference:
Testicular fibrothecoma: a morphologic and immunohistochemical study of 16 cases. Zhang M, Kao CS, Ulbright TM, Epstein JI. Am J Surg Pathol. 2013; 37:1208-14.
