Testis & epididymis
Sex cord-stromal tumors
Adult granulosa cell
Author: Swapnil U. Rane, M.D.
Topic Completed: 1 July 2013
Minor changes: 10 September 2020
Copyright: 2002-2020, PathologyOutlines.com, Inc.
PubMed Search: Adult granulosa cell tumor testis
Related topics: Juvenile granulosa cell tumor
Table of Contents
Definition / general | Epidemiology | Clinical features | Radiology description | Radiology images | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Electron microscopy description | Molecular / cytogenetics description | Differential diagnosisCite this page: Rane S. Adult granulosa cell. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/testisgranulosa.html. Accessed September 19th, 2020.
Definition / general
- Tumor with cells resembling the granulosa cells of ovary
Epidemiology
- Rare
- Average age at presentation 44 years
Clinical features
- Usually slow growing, nonfunctional testicular mass
- Gynecomastia in 25%
- Also elevated serum inhibin (like other sex cord stromal tumors), elevated serum Müllerian inhibiting hormone (like ovarian granulosa cell tumors)
- Usually benign; metastases in 10 - 20% (see prognostic factors)
Radiology description
- Not specific - cannot differentiate between benign and malignant tumor
Radiology images
Images hosted on other servers:
MRI
Prognostic factors
- May metastasize (Hum Pathol 1993;24:1120, Urol Int 2005;75:91)
- Poorer outcome if large size (most important predictive factor for malignancy is > 5 cm), necrosis, hemorrhage, vascular invasion (Arch Pathol Lab Med 2011;135:143)
Case reports
- 37 year old man (Case Rep Pathol 2013;2013:932086)
- 48 year old man (Arch Pathol Lab Med 2000;124:1525)
Treatment
- Radical orchiectomy
- Enucleation can be attempted if tumor is small and there is no evidence of metastases at presentation
Gross description
- Microscopic to 13 cm in diameter (average 5 cm)
- Circumscribed, sometimes encapsulated
- Yellow, solid cut surface, may have small cysts
- Necrosis and hemorrhage are unusual
Microscopic (histologic) description
- Most common patterns are microfollicular and diffuse
- Other patterns
- Trabecular
- Macrofollicular
- Gyriform
- Pseudosarcomatous
- Call-Exner bodies (central eosinophillic material, around which cells are arranged): most commonly seen with microfollicular pattern
- Round to oval nuclei with nuclear grooving (coffee bean nuclei) and peripherally placed multiple nucleoli
- Commonly thecomatous differentiation
- Smooth muscle or osteoid differentiation may also be seen
- No / rare mitoses (unlike the juvenile type), pleomorphism, necrosis
Microscopic (histologic) images
Images hosted on other servers:
Call-Exner Bodies
Trabecular and diffuse pattern
CD99 / MIC2
Calretinin
Positive stains
- Vimentin, inhibin
- Also MIC2 / CD99, S100, SMA, pancytokeratins and low molecular weight cytokeratins
- Other sex cord stromal markers like calretinin and steroidogenic factor 1 can also be positive
- Desmin
Negative stains
- EMA, PLAP, chromogranin, synaptophysin, c-kit
- CD30, beta hCG, alpha fetoprotein, CD45 / LCA, ER / PR
Electron microscopy description
- Dual epithelial - smooth muscle differentiation, similarity to primitive Sertoli cells and pre-ovulatory granulosa cells
- Granulosa cells with continuous basal lamina, cytoplasmic filaments with evenly distributed dense bodies resembling smooth muscle (Am J Surg Pathol 1996;20:72)
Molecular / cytogenetics description
- No specific genetic abnormality identified but most studies performed on juvenile granulosa cell tumors
Differential diagnosis
