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Presented by Jonathan Epstein, M.D. and prepared by Maryam Farinola M.D.
Case 6: 15-year old female with resection of gonads.
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1. Question
Week 142: Case 6
15-year old female with resection of gonads.mages/063003case6fig1.jpg
mages/063003case6fig2.jpg
mages/063003case6fig4.jpgCorrect
Answer: Sertoli cell nodules in setting of testicular feminization
Histology: The testis is composed of immature seminiferous tubules. At low magnification, the seminiferous tubules are grouped into several nodules. In between the seminiferous tubules are collections of unremarkable Leydig cells. Focally, one of the nodules contains ovarian-type stroma.
Discussion: These findings are classic for what is seen in testicular feminization syndrome. These individuals are typically 46 XY in terms of their chromosomes. However, because they lack functioning androgen receptors, they are phenotypically females. In addition to having ovarian-type stroma focally as seen in the current case, they may also have structures resembling fallopian tubes. These Sertoli cell nodules are multifocal and more resemble crowded seminiferous tubules than a distinct tumor mass. In contrast, a Sertoli-Leydig cell tumor would look distinct from the adjacent surrounding testes. These gonads are resected because they are at increased risk of developing testicular tumors (approximately 5%).
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Answer: Sertoli cell nodules in setting of testicular feminization
Histology: The testis is composed of immature seminiferous tubules. At low magnification, the seminiferous tubules are grouped into several nodules. In between the seminiferous tubules are collections of unremarkable Leydig cells. Focally, one of the nodules contains ovarian-type stroma.
Discussion: These findings are classic for what is seen in testicular feminization syndrome. These individuals are typically 46 XY in terms of their chromosomes. However, because they lack functioning androgen receptors, they are phenotypically females. In addition to having ovarian-type stroma focally as seen in the current case, they may also have structures resembling fallopian tubes. These Sertoli cell nodules are multifocal and more resemble crowded seminiferous tubules than a distinct tumor mass. In contrast, a Sertoli-Leydig cell tumor would look distinct from the adjacent surrounding testes. These gonads are resected because they are at increased risk of developing testicular tumors (approximately 5%).
