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Presented by Dr. Andres Matoso and prepared by Dr. Maryam Shabihkhani
Adult male with testicular mass
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Adult male with testicular mass
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Correct: B
Histology: Well-circumscribed tumor composed of tubules and nests of tumor cells with small or inconspicuous nucleoli and clear cytoplasm in a hyalinized stroma.
Discussion: This is the classic morphology of a benign Sertoli cell tumor. Sertoli cell tumors are infrequent and constitute less than 1% of all testicular tumors. The most frequent clinical presentation is a painless testicular mass. Occasionally, patients will present with gynecomastia. The majority are sporadic but some are associated with androgen insensitivity syndrome, Carney syndrome or Peutz-Jeghers syndrome. Cord-like arrangements of the cells in scanty pauci-cellular stroma could mimic a neuroendocrine tumor, especially because a subset of Sertoli cell tumors are positive for neuroendocrine markers. Inhibin is positive but less frequently than in Leydig cell tumors. Other positive markers include EMA and SF1. Germ cell markers including PLAP, OCT3/4 and CD30 are negative. Size over 5 cm, cellular atypia, increased mitotic activity, necrosis, infiltrative pattern, extratesticular extension and vascular invasion are associated with malignancy.
References:
1. Hum Pathol. 2017 Oct;68:99-102.
2. Arch Pathol Lab Med. 2012 Apr;136(4):435-46.Incorrect
Correct: B
Histology: Well-circumscribed tumor composed of tubules and nests of tumor cells with small or inconspicuous nucleoli and clear cytoplasm in a hyalinized stroma.
Discussion: This is the classic morphology of a benign Sertoli cell tumor. Sertoli cell tumors are infrequent and constitute less than 1% of all testicular tumors. The most frequent clinical presentation is a painless testicular mass. Occasionally, patients will present with gynecomastia. The majority are sporadic but some are associated with androgen insensitivity syndrome, Carney syndrome or Peutz-Jeghers syndrome. Cord-like arrangements of the cells in scanty pauci-cellular stroma could mimic a neuroendocrine tumor, especially because a subset of Sertoli cell tumors are positive for neuroendocrine markers. Inhibin is positive but less frequently than in Leydig cell tumors. Other positive markers include EMA and SF1. Germ cell markers including PLAP, OCT3/4 and CD30 are negative. Size over 5 cm, cellular atypia, increased mitotic activity, necrosis, infiltrative pattern, extratesticular extension and vascular invasion are associated with malignancy.
References:
1. Hum Pathol. 2017 Oct;68:99-102.
2. Arch Pathol Lab Med. 2012 Apr;136(4):435-46.
