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Presented by Dr. Jonathan Epstein and prepared by Austin McCuiston.
A 55 year-old man presented with a testicular mass that measured 1.5 cm on ultrasound.
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Question 1 of 1
1. Question
A 55 year-old man presented with a testicular mass that measured 1.5 cm on ultrasound.
Correct
Answer: Sertoli cell tumor
Histological Description: The lesion is well-circumscribed although not encapsulated. At low magnification there are bands of very eosinophilic collagen dividing tumor. The cells arranged in nests, cords, solid areas with scattered of round to elongated tubules. Cell are polygonal to cuboidal with eosinophilic cytoplasm with focal areas containing clear vacuoles. Nuclear features are bland with central small nucleoli and a virtual absence of mitotic figures.
Discussion: This case is typical for a benign Sertoli cell tumor. One of the most characteristic feature of these lesions is the bands of very eosinophilic collagen dividing the tumor, which is not seen in any of the other entities in the differential diagnosis. In contrast to the “salt and pepper” speckled chromatin seen in carcinoid tumors, Sertoli cell tumors have a central small nucleolus, just as in normal Sertoli cells. The presence of clear vacuoles, when present, is also a good diagnostic clue for a sex cord stromal tumor, as it indicates lipid production. Immunohistochemically, Sertoli cell tumors are variably focally positive for cytokeratin AE1/AE3, usually positive for inhibin alpha, steroid factor 1 (SF1), and calretinin. Synaptophysin can be positive in almost half of the cases with higher rate of chromogranin staining, which can mimic carcinoid tumor. In contrast, a carcinoid tumor and other carcinomas would typically be diffusely positive for cytokeratin AE1/AE3, and negative for inhibin alpha and calretinin. Benign Sertoli cell tumors are typically small (<5 cm), lack atypia, rare mitoses, lack necrosis and vascular invasion. Some experts prefer not to definitively diagnose Sertoli cell tumors as either benign or malignant but rather classify them as having a favorable or unfavorable prognosis based on their histology. In my practice, if a Sertoli cell tumor lacks any atypical feature, I definitively diagnose them as “Benign Sertoli cell tumor” so as to allay any concerns for patients. In cases with only 1 or 2 atypical features, but otherwise benign, I use the term “Sertoli cell tumor with atypical features” and say the prognosis is uncertain. Most malignant Sertoli cell tumors have multiple malignant features.
Incorrect
Answer: Sertoli cell tumor
Histological Description: The lesion is well-circumscribed although not encapsulated. At low magnification there are bands of very eosinophilic collagen dividing tumor. The cells arranged in nests, cords, solid areas with scattered of round to elongated tubules. Cell are polygonal to cuboidal with eosinophilic cytoplasm with focal areas containing clear vacuoles. Nuclear features are bland with central small nucleoli and a virtual absence of mitotic figures.
Discussion: This case is typical for a benign Sertoli cell tumor. One of the most characteristic feature of these lesions is the bands of very eosinophilic collagen dividing the tumor, which is not seen in any of the other entities in the differential diagnosis. In contrast to the “salt and pepper” speckled chromatin seen in carcinoid tumors, Sertoli cell tumors have a central small nucleolus, just as in normal Sertoli cells. The presence of clear vacuoles, when present, is also a good diagnostic clue for a sex cord stromal tumor, as it indicates lipid production. Immunohistochemically, Sertoli cell tumors are variably focally positive for cytokeratin AE1/AE3, usually positive for inhibin alpha, steroid factor 1 (SF1), and calretinin. Synaptophysin can be positive in almost half of the cases with higher rate of chromogranin staining, which can mimic carcinoid tumor. In contrast, a carcinoid tumor and other carcinomas would typically be diffusely positive for cytokeratin AE1/AE3, and negative for inhibin alpha and calretinin. Benign Sertoli cell tumors are typically small (<5 cm), lack atypia, rare mitoses, lack necrosis and vascular invasion. Some experts prefer not to definitively diagnose Sertoli cell tumors as either benign or malignant but rather classify them as having a favorable or unfavorable prognosis based on their histology. In my practice, if a Sertoli cell tumor lacks any atypical feature, I definitively diagnose them as “Benign Sertoli cell tumor” so as to allay any concerns for patients. In cases with only 1 or 2 atypical features, but otherwise benign, I use the term “Sertoli cell tumor with atypical features” and say the prognosis is uncertain. Most malignant Sertoli cell tumors have multiple malignant features.
