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Presented by George Netto, MD and prepared by Marc Lewin, M.D.
Case 3: A 5 month old boy with 1.6 cm testicular mass.
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1. Question
Week 287: Case 3
A 5 month old boy with 1.6 cm testicular mass/images/10-23-06case3a.jpg
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/images/10-23-06case3d.jpgCorrect
Answer: Sertoli cell tumor
Histology: The well circumscribed tumor is surrounded by non-neoplastic immature testicular tissue. The neoplastic cells contain moderate amount of lightly eosinophilic to clear cytoplasm and are, for the most part, arranged in nests and cords with only focal tubular formations. The latter are occasionally dilated. The tumor cells show moderate nuclear pleomorphism. Their nuclei have stippled chromatin pattern with rare prominent nucleoli. Nuclear grooves are absent. Mitotic activity is brisk (more than 10 per 10 HPF). There is no significant necrosis or evidence of vascular invasion. The tumor stained positive for Inhibin and cytokeratin CAM 5.2 and was negative for PLAP and AFP.
Discussion: The reported proportion of sertoli cell tumors occurring in pediatric patients vary widely with recent studies showing a much lower rates. This could be due to misclassification of juvenile granulosa cell tumor as sertoli cell tumors in older studies. In the study by Young et al., 12% of sertoli cell tumors behaved in a malignant fashion with metastases to inguinal, retroperitoneal, lung or bone as late as 12 years after diagnosis. The current tumor should be considered of uncertain malignant potential due to the high mitotic rate and the presence of moderate cytologic atypia. Features associated with malignant behavior in sertoli cell tumors include size (5 cm or more), presence of vascular invasion, presence of necrosis, mitotic activity (>5 per 10 HPF) and moderate to severe nuclear atypia.
Reference(s):
– Young RH : Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. Mod Pathol. 2005;18 Suppl 2:S81-98.
– Young RH, Koelliker DD, Scully RE.: Sertoli cell tumors of the testis, not otherwise specified: a clinicopathologic analysis of 60 cases. Am J Surg Pathol. 1998 Jun;22(6):709-21.Incorrect
Answer: Sertoli cell tumor
Histology: The well circumscribed tumor is surrounded by non-neoplastic immature testicular tissue. The neoplastic cells contain moderate amount of lightly eosinophilic to clear cytoplasm and are, for the most part, arranged in nests and cords with only focal tubular formations. The latter are occasionally dilated. The tumor cells show moderate nuclear pleomorphism. Their nuclei have stippled chromatin pattern with rare prominent nucleoli. Nuclear grooves are absent. Mitotic activity is brisk (more than 10 per 10 HPF). There is no significant necrosis or evidence of vascular invasion. The tumor stained positive for Inhibin and cytokeratin CAM 5.2 and was negative for PLAP and AFP.
Discussion: The reported proportion of sertoli cell tumors occurring in pediatric patients vary widely with recent studies showing a much lower rates. This could be due to misclassification of juvenile granulosa cell tumor as sertoli cell tumors in older studies. In the study by Young et al., 12% of sertoli cell tumors behaved in a malignant fashion with metastases to inguinal, retroperitoneal, lung or bone as late as 12 years after diagnosis. The current tumor should be considered of uncertain malignant potential due to the high mitotic rate and the presence of moderate cytologic atypia. Features associated with malignant behavior in sertoli cell tumors include size (5 cm or more), presence of vascular invasion, presence of necrosis, mitotic activity (>5 per 10 HPF) and moderate to severe nuclear atypia.
Reference(s):
– Young RH : Sex cord-stromal tumors of the ovary and testis: their similarities and differences with consideration of selected problems. Mod Pathol. 2005;18 Suppl 2:S81-98.
– Young RH, Koelliker DD, Scully RE.: Sertoli cell tumors of the testis, not otherwise specified: a clinicopathologic analysis of 60 cases. Am J Surg Pathol. 1998 Jun;22(6):709-21.
