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Presented by Dr. Epstein and prepared by Austin McCuiston.
A 45 year old male was noted to have an asymptomatic 1 cm. testicular mass.
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1. Question
A 45 year old male was noted to have an asymptomatic 1 cm. testicular mass.
Correct
Answer: Large cell calcifying Sertoli cell tumor
Histology: The lesion is well-circumscribed. Areas of the tumor are fibrotic containing small nests of cells with abundant eosinophilic cytoplasm. Nuclei are uniform with central prominent nucleoli, lacking mitotic activity. The striking feature of this case is the dense areas of calcification with focal bone formation.
Discussion: This case shows the classic histology of large cell calcifying Sertoli cell tumor. There are no other tumors in the testis characterized by large areas of calcification. Although the cells resemble Leydig cells more than Sertoli cells, these tumors are considered the latter because occasionally there is tubular formation, and can occasionally show an intratubular component in adjacent seminiferous tubules. Most cases are sporadic but approximately 40% are associated with the Carney complex. Malignant tumors are uncommon and have the same criteria for malignancy as other Sertoli or Leydig cell tumors (>5 cm; >3 mitotic figures per 10 HPF; atypia; necrosis; lymphovascular invasion; very infiltrative growth). Immunohistochemically, they label like other sex cord stromal tumors with the most sensitive marker being SF1 and also inhibin.
Incorrect
Answer: Large cell calcifying Sertoli cell tumor
Histology: The lesion is well-circumscribed. Areas of the tumor are fibrotic containing small nests of cells with abundant eosinophilic cytoplasm. Nuclei are uniform with central prominent nucleoli, lacking mitotic activity. The striking feature of this case is the dense areas of calcification with focal bone formation.
Discussion: This case shows the classic histology of large cell calcifying Sertoli cell tumor. There are no other tumors in the testis characterized by large areas of calcification. Although the cells resemble Leydig cells more than Sertoli cells, these tumors are considered the latter because occasionally there is tubular formation, and can occasionally show an intratubular component in adjacent seminiferous tubules. Most cases are sporadic but approximately 40% are associated with the Carney complex. Malignant tumors are uncommon and have the same criteria for malignancy as other Sertoli or Leydig cell tumors (>5 cm; >3 mitotic figures per 10 HPF; atypia; necrosis; lymphovascular invasion; very infiltrative growth). Immunohistochemically, they label like other sex cord stromal tumors with the most sensitive marker being SF1 and also inhibin.
