1 September 2005 – Case of the Week #18

 

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We thank Dr. Juan José Segura Fonseca, Departamento de Patología, Hospital San Juan de Dios, San José, Costa Rica, for contributing this case and the discussion.  We invite you to contribute a Case of the Week by emailing NPernick@PathologyOutlines.com with microscopic images (any size, we will shrink if necessary) in JPG or GIF format, a short clinical history, your diagnosis and any other images (gross, immunostains, EM, etc.) that you have and that may be helpful or interesting.  We will write the discussion (unless you want to contribute to it), list you as the contributor, and send you a check for $35 (US) for your time if we use the case.  Please only send cases with a definitive diagnosis. 

 

Case of the Week #18

 

A 23 year old man complained of pain in the right testis.  An ultrasound examination disclosed a small, solid, well-demarcated intraparenchymal tumor.  A total radical orchiectomy was performed.  A small, hard, white, solid tumor measuring 0.7 cm in diameter was found.

 

Microscopic images: low powerfigure 1

high power figure 2, figure 3, figure 4, figure 5, figure 6

 

What is your diagnosis? 

 

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Diagnosis:  Sclerosing Sertoli cell tumor of the testis.

 

Discussion

 

Sertoli cell tumors comprise <2% cent of all primary testicular tumors.  They have been subtyped as classical Sertoli cell tumor, large cell calcifying Sertoli cell tumor, sclerosing Sertoli cell tumor and Sertoli cell tumors NOS.

 

These tumors were first described in 1991 by Zukerberg et al, who reported 10 cases of a new Sertoli cell tumor subtype (AJSP 1991;15:829).   To date, less than 30 cases have been reported.  They occur in men with a mean age of 30 years, range 18 to 80 years, and are not associated with hormone production.  They are typically well circumscribed, small (0.4 to 1.5 cm in diameter) and yellow-white-tan.  Histologically, they are characterized by small solid cords, anastomosing tubules and thin cords of Sertoli cells in a prominent fibrous sclerosing stroma  with thick collagenous bands.  The Sertoli cells are small to medium size with pale cytoplasm and occasional large lipid vacuoles.  The nuclei are typically bland.  There is usually no/rare atypia and mitotic figures.  The fibrous stroma may entrap non-neoplastic tubules, resembling immature tubules in Sertoli cell nodules of cryptorchid testes (Ulbright: Tumors of the Testis, Adnexa, Spermatic Cord, and Scrotum; AFIP Third Series, Volume 25; 1999).  The differential diagnosis includes adenomatoid tumor (usually paratesticular, no prominent fibrosis) and metastatic carcinoma (marked atypia).

 

To date, there are no reports of recurrence or metastases.

 

 

ADDITIONAL REFERENCES

 

1. Salvador-Gallegos S, Guerrero-Medrano J.  Tumor de células de Sertoli esclerosante.  Presentación de un caso y revisión de la literatura.  Urología (México) 2004;64:85.

 

2. Farhat Abbas  NW, Akbar SH. Sclerosing Sertoli cell tumor of the testis. J Coll Physicians Surg Pak. 2005; 15:437

 

 

Nat Pernick, M.D.
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