Testis & epididymis
Sex cord-stromal tumors
Sertoli cell tumor

Editor-in-Chief: Debra L. Zynger, M.D.
Oleksandr Kravtsov, M.D.
Hector Mesa, M.D., Ph.D.

Minor changes: 12 April 2021

Copyright: 2002-2021, PathologyOutlines.com, Inc.

PubMed Search: Testis Sertoli cell tumor[TI] full text[SB] pathology

Oleksandr Kravtsov, M.D.
Hector Mesa, M.D., Ph.D.
Page views in 2020: 5,810
Page views in 2021 to date: 3,690
Cite this page: Kravtsov O, Mesa H. Sertoli cell tumor. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisSertoliNOS.html. Accessed May 11th, 2021.
Definition / general
  • Sex cord stromal tumor of testis composed of cells showing features of fetal, prepubertal, adult or atrophic Sertoli cells, at least focally
Essential features
  • Second most common type of pure sex cord stromal tumor after Leydig cell tumor
  • Most are small, unilateral tumors in adults and the vast majority are benign
  • Characterized by tubular or cord pattern, at least focally
  • Positive for SF1 and nuclear beta catenin
  • Variable and inconsistent expression of calretinin, inhibin A, androgen receptor, CD56
  • Negative for SALL4, OCT4 and other germ cell markers
  • Poor response to therapy when metastatic
Terminology
  • Androblastoma (obsolete)
ICD coding
  • ICD-O:
    • 8640/1 - Sertoli cell tumor
    • 8640/3 - Malignant Sertoli cell tumor
Epidemiology
  • < 1% of testicular tumors
  • Rare before age 20; mean age 45 years
Etiology
Clinical features
Diagnosis
  • For suspected testicular mass, the first test is scrotal ultrasound (US) (sensitivity 95%, specificity 97%)
  • If US confirms a lesion, the patient should be immediately referred to a urologist for evaluation and management
  • Men 15 to 44 years old with retroperitoneal mass / metastases should undergo testicular examination and scrotal US
  • Evaluate serum markers
  • Biopsy of testicular tumors is in general not performed, to prevent tumor seeding
  • Staging:
    • In clinically stable patients, imaging may be performed before or after orchiectomy
    • Imaging: computed tomography (CT) scan of the abdomen / pelvis with intravenous contrast, chest radiograph (CXR)
    • Noncontrast chest CT should be performed if CXR is abnormal
  • Reference: Med Clin North Am 2018;102:251
Laboratory
  • Serum tumor markers:
    • Beta human chorionic gonadotropin (hCG), alpha fetoprotein (AFP) should be normal and are used to exclude nonseminomatous germ cell tumors
    • Lactate dehydrogenase (LDH) to assess global tumor burden
Radiology description
  • Ultrasound: solitary hypoechoic lesion; not helpful in distinguishing from germ cell tumors
Radiology images

Images hosted on other servers:
Hypoechoic lesion

Hypoechoic lesion

Prognostic factors
  • Vast majority are benign, ~ 5% cases are malignant
  • Tumors with sclerosis > 50% almost invariably benign (Am J Surg Pathol 2014;38:510)
  • Features associated with malignancy: extratesticular spread, size > 5 cm, lymphovascular invasion, high grade cytological atypia, tumor necrosis, mitotic index > 5/10 high power fields (Am J Surg Pathol 1998;22:709)
  • Very rarely tumors without malignant histology metastasize
Case reports
Treatment
  • Orchiectomy (total or partial) is treatment of choice
  • Retroperitoneal lymph node dissection for malignant Sertoli cell tumors
  • No specific therapy; poor response to chemotherapy or radiotherapy
  • Reference: Med Clin North Am 2018;102:251
Gross description
  • Cut surface usually homogenous white or yellowish
  • Cystic component present in ~ 30% of cases (Am J Surg Pathol 1998;22:709)
  • Benign: well circumscribed, most between 2 - 5 cm (Am J Surg Pathol 2014;38:510)
  • Malignant: > 5 cm, poor circumscription, extratesticular extension, necrosis, hemorrhage
Gross images

Images hosted on other servers:
Tumor in lower pole

Tumor in lower pole

Microscopic (histologic) description
  • Architecture: tubular (lumen), cords (no lumen), tubulopapillary present at least focally
  • Other patterns: macro or microcystic, nested, trabecular, whorled, solid, retiform, pseudopapillary; most tumors show mixed patterns
  • Nuclei: bland, uniform, round to ovoid in benign tumors; small hyperchromatic or large with prominent nucleoli in malignant tumors
  • Cytoplasm: usually clear and abundant but extremely variable, ranging from scant, foamy, eosinophilic to markedly lipidized; hyaline globules are common
  • Stroma: variable, basement membrane-like material around tubules, sclerotic, myxoid, edematous, angiomatous
  • If sclerosis > 50% → sclerotic variant (now considered subtype of Sertoli cell tumor, NOS)
  • Inflammatory cells usually absent, rarely prominent
  • References: Histopathology 2017;70:513, Ulbright: Tumors of the Testis and Adjacent Structures (AFIP Atlas of Tumor Pathology, Series 4), 1st Edition, 2014, Am J Surg Pathol 2015;39:1390
Microscopic (histologic) images

Contributed by Thomas Ulbright, M.D.

Architectural patterns
Cords

Cords

Tubules

Tubules

Tubopapillary

Tubopapillary

Macrocystic

Macrocystic

Microcystic Microcystic

Microcystic




Whorled

Whorled

Trabecular

Trabecular


Cells
Abundant clear cytoplasm (most common)

Abundant clear cytoplasm (most common)

Heavily lipidized

Heavily lipidized



Malignant
Marked cytologic atypia

Marked cytologic atypia

Tumor necrosis

Tumor necrosis

Lymphovascular invasion

Lymphovascular invasion

High N/C ratio, increased mitotic / apoptic activity

High N/C ratio,
increased
mitotic / apoptotic
activity

Cytology description
Cytology images

Contributed by Indiana University School of Medicine
Tubular formations, monotonous small cells (Pap)

Tubular formations, monotonous small cells (Pap)

Papillary groups and dyscohesive cells (Pap)

Papillary groups and discohesive cells (Pap)

Negative stains
Electron microscopy description
Molecular / cytogenetics description
Sample pathology report
  • Left testis, orchiectomy:
    • Sertoli cell tumor, not otherwise specified (see comment and synoptic report)
    • Comment: The morphologic features are diagnostic of Sertoli cell tumor, not otherwise specified. No features of malignancy are identified in this tumor (i.e. extratesticular spread, size > 5 cm, high grade cytologic atypia, > 5 mitotic figures per 10 high power fields, necrosis or lymphovascular invasion).
Differential diagnosis
Board review style question #1

A 60 year old man presents with a 1.1 cm mass in the left testis. The tumor is positive for SF1, nuclear beta catenin, androgen receptor, variable for inhibin A and calretinin and negative for SALL4. What is the most likely diagnosis?

  1. Adenomatoid tumor
  2. Seminoma
  3. Sertoli cell tumor, NOS
  4. Yolk sac tumor
Board review style answer #1
C. Sertoli cell tumor, NOS

Comment Here

Reference: Sertoli cell, NOS
Board review style question #2

What is the characteristic immunoprofile of a testicular Sertoli cell tumor, NOS?

  1. Positive for SF1, calretinin, chromogranin, synaptophysin; negative for SALL4 and beta catenin
  2. Positive for SALL4; negative for SF1, inhibin A and calretinin
  3. Positive for SF1, calretinin, inhibin A, beta catenin (nuclear); negative for SALL4, chromogranin, synaptophysin
  4. Positive for CD45; negative for SF1, inhibin A and SALL4
Board review style answer #2
C. Positive for SF1, calretinin, inhibin A, beta catenin (nuclear); negative for SALL4, chromogranin, synaptophysin

Comment Here

Reference: Sertoli cell, NOS
Back to top
Image 01 Image 02