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Presented by Dr. Jonathan Epstein and prepared by Dr. Sintawat Wangsiricharoen.
A 58 year old man presented with a 1 cm solid mass in the testis.
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Question 1 of 1
1. Question
A 58 year old man presented with a 1 cm solid mass in the testis. Choose the correct diagnosis.
Correct
Answer: A. Sertoli cell tumor
Histology: The lesion consists of a well-circumscribed mass. Cells are arranged primarily in cords of cells within a hyalinized stroma. Nuclei have a single small nucleolus with bland nuclear features. Mitotic activity is not appreciable and the lesion lacks necrosis or vascular invasion.
Discussion: The major differential diagnosis would be between a benign Sertoli cell tumor and carcinoid tumor, given the bland cytology and arrangement of cells into cords. Carcinoid tumors typically have “salt and pepper” nuclear chromatin and 10% of cases have a desmoplastic reaction but typically not hyalinized stroma. Immunohistochemically, there is some overlap between these two entities in that both can be positive for synaptophysin and chromogranin. However, keratin AE1/AE3 tends to be diffuse in carcinoid tumor and only focally positive in Sertoli cell tumors. Inhibin is positive in most but not all Sertoli cell tumors. A more sensitive marker is SF-1 which is positive in almost all of Sertoli cell tumors. Carcinoid tumors are negative for inhibin and SF-1. Sertoli cell nodules are small typically multifocal nodules. They are composed of crowded nests resembling fetal seminiferous tubules or tubules lined by immature Sertoli cells that lack atypia and contain luminal hyaline material, which in some cases form laminated calcifications. Granulosa cell tumors have characteristic nuclear grooves.
Incorrect
Answer: A. Sertoli cell tumor
Histology: The lesion consists of a well-circumscribed mass. Cells are arranged primarily in cords of cells within a hyalinized stroma. Nuclei have a single small nucleolus with bland nuclear features. Mitotic activity is not appreciable and the lesion lacks necrosis or vascular invasion.
Discussion: The major differential diagnosis would be between a benign Sertoli cell tumor and carcinoid tumor, given the bland cytology and arrangement of cells into cords. Carcinoid tumors typically have “salt and pepper” nuclear chromatin and 10% of cases have a desmoplastic reaction but typically not hyalinized stroma. Immunohistochemically, there is some overlap between these two entities in that both can be positive for synaptophysin and chromogranin. However, keratin AE1/AE3 tends to be diffuse in carcinoid tumor and only focally positive in Sertoli cell tumors. Inhibin is positive in most but not all Sertoli cell tumors. A more sensitive marker is SF-1 which is positive in almost all of Sertoli cell tumors. Carcinoid tumors are negative for inhibin and SF-1. Sertoli cell nodules are small typically multifocal nodules. They are composed of crowded nests resembling fetal seminiferous tubules or tubules lined by immature Sertoli cells that lack atypia and contain luminal hyaline material, which in some cases form laminated calcifications. Granulosa cell tumors have characteristic nuclear grooves.
