Sclerosing Sertoli Cell Tumor of the Testis: A Study of 20 Cases
Jennifer B Kum, Muhammad T Idrees, Thomas M Ulbright. Indiana University, Indianapolis, IN
Background: Sclerosing Sertoli cell tumor (SSCT) is rare, with only 19 previously reported cases. Most have been small, circumscribed masses and none has had a malignant course, but there is limited follow-up. We have examined 20 new SSCTs to better delineate their features and report long-term follow-up.
Design: We retrieved and reviewed H&E slides from 20 cases of SSCT (15 orchiectomies, 5 excisonal biopsies) from in-house and consultation files. We required at least focal tubule formation by sex cord cells in a dense, hypocellular fibrous stroma that comprised at least 50% of the lesion. Morphologic and clinical data were collected.
Results: The patients ranged from 23-52 yrs old (mean, 37). Eleven SSCTs were left sided, 7 right, 2 unknown and none bilateral. The average size was 1.7 cm (range, 0.5 to 6 cm). In most the stroma represented 50-70% of the mass but in 2 it was at least 80%. The tumors formed cords, trabeculae, small nests, focal tubules (sometimes with a pseudovascular appearance) and rarely single cells. The cells had small, round, oval to polygonal nuclei with finely granular chromatin, small nucleoli and small amounts of pale, eosinophilic cytoplasm. No significant atypia or necrosis was seen and only 1 had identifiable mitotic figures (1-2/10 hpfs). Clinical follow-up in 14 patients (8 months-16 years, mean 6.8 years) showed 8 alive and well, 5 alive with unknown disease status and 1 patient, who presented with bone metastases, dead of disease at 27 months. The only features in the fatal case that differed from all others were the presence of lymphovascular invasion and lack of circumscription. Additionally it was 3.8 cm. Combining our cases with previously reported ones shows that SSCTs are unilateral, usually small (79% ≤ 2 cm) tumors that occur in a wide age range (18-80 yrs, mean 34), lack necrosis and rarely (<5%) have elevated mitotic rates or significant atypia. Only 1 of 26 with follow-up (mean, 10 years) was clinically malignant and it was 3.8 cm with invasive growth.
Conclusions: Sclerosing Sertoli cell tumors less than 2 cm with the typical features and lacking those associated with malignancy in Sertoli cell tumors NOS (Am J Surg Pathol 22(6): 709-721,1998) have a negligible risk of metastasis. This group (∼80%) is adequately managed by orchiectomy alone.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 177, Wednesday Afternoon