Testis and epididymis
Sex cord stromal tumors
Sertoli - Leydig cell tumor

Author: Swapnil U. Rane, M.D. (see Authors page)

Revised: 13 June 2017, last major update February 2014

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PubMed search: Sertoli - Leydig cell tumor [title] testis

Cite this page: Sertoli - Leydig cell tumor. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/testissertolileydig.html. Accessed December 18th, 2017.
Definition / general
  • Group of tumors composed of variable proportions of Sertoli cells, Leydig cells and in the case of intermediate and poorly differentiated neoplasms, primitive gonadal stroma and sometimes heterologous elements
  • More common in ovary than testis
Terminology
  • Previously known as androblastoma or arrhenoblastoma
Epidemiology
  • Extremely rare (<1% of all testicular tumors)
  • Occurs at any age but most often in young adults
  • Occasionally associated with complete androgen insensitivity
Sites
  • Normally descended testis
Etiology
Clinical features
  • Gynecomastia occurs in 1/3, most common presentation
  • May have enlargement of testis
Diagnosis
  • Definitive diagnosis based on histology
Laboratory
  • Elevated levels of testosterone may be present
  • AFP, β-HCG and LDH levels are usually normal
Radiology description
  • Hypoechoic well circumscribed lesion is commonly seen on ultrasound imaging
  • However, these findings are not specific and do not help to differentiate from other tumors or between benign and malignant tumors
Prognostic factors
  • Most tumors are benign
  • Malignancy is associated with poorly differentiated histology and older age
  • Prognostic factors are similar as those for sex cord stromal tumors in general
Case reports
Treatment
  • High inguinal orchidectomy is treatment of choice as it is difficult to rule out other more aggressive tumors without histological examination
  • Some evidence suggests wide local excision instead of radical orchidectomy may be adequate in tumors without any demonstrable clinical / radiological / biochemical evidence of malignancy
Gross description
  • Yellow to yellowish white
  • Entirely or predominantly solid, often lobulated and encapsulated
  • Usually restricted to the testis
Microscopic (histologic) description
  • Histologically similar to ovarian counterpart
  • Diagnostic features are unequivocal tubular component of Sertoli cell type or sex cord patterns typical of ovarian Sertoli - Leydig cell tumor, as well as a neoplastic stromal component that contains at least focal Leydig cells
  • Most reported cases were of intermediate differentiation but well differentiated (J Urol 1992;148:883) and poorly differentiated tumors have also been described
  • As in ovarian cases, retiform patterns (Ulbright: Tumors of the Testis, Adnexa, Spermatic Cord, and Scrotum (AFIP Third Series, 1999) and heterologous elements have been described (Cancer Genet Cytogenet 1989;41:105)
  • Well differentiated (Meyer type I):
    • Nodular / tubular (hollow > solid), easily identifiable Leydig cells and Sertoli cells in a tubular pattern
    • Crystals of Reinke in 20%
    • Often associated with androgen insensitivity syndrome
  • Intermediate differentiated (Meyer type II):
    • Outlines of immature tubules with immature Sertoli cells and large Leydig cells
    • May have mucus filled epithelial cells, cartilage and skeletal muscle
  • Poorly differentiated (Meyer type III):
    • Resembles indifferent gonad
    • May have sarcomatous appearance, Leydig cells in 2/3
    • May have mucus filled epithelial cells, cartilage, skeletal muscle
Microscopic (histologic) images

Images hosted on other servers:

Various images

Negative stains
Differential diagnosis
  • Pure sex cord stromal tumors:
    • Show only one cell type and not more than an occasional microscopic focus of other elements
    • Presence of more than occasional occurrence of two or more sex cord stromal cell types warrants a diagnosis of mixed sex cord stromal tumor
  • Sex cord stromal tumor with entrapped germ cells (Am J Surg Pathol 2000;24:535) and mixed germ cell-sex-cord stromal tumors
    • Show clusters of germ cells in the center of the tumor
    • Only one sex cord stromal cell type present