Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

tinguished from Sertoli cell nodules, and
Leydig cell tumours, and rete adenomas.
Sertoli cell nodules, however, are small,
incidentally discovered, non neoplastic
lesions composed of aggregates of small
tubules lined by immature Sertoli cells
and contain prominent basement membrane
deposits. The rete adenomas
occur within the dilated lumens of the
rete testis.
Prognosis
Most Sertoli cell tumours are benign.
Malignant Sertoli cell tumour
ICD-O code 8640/3
Epidemiology
Malignant Sertoli cell tumour not otherwise
specified is rare {1194}. Less than 50
cases have been reported. Age distribution
does not differ from that of the benign
form, occurring from childhood to old age.
Clinical features
Some patients present with metastases;
most commonly to inguinal, retroperitoneal
and/or supraclavicular lymph
nodes. Approximately one third has
gynecomastia at presentation, but apart
from that no specific lesions or syndrome
are known to be associated with malignant
Sertoli cell tumour.
Macroscopy
They tend to be larger than the benign
counterparts {2894}, usually more than 5
cm but range 2 to 18 cm. The macroscopic
appearance may differ from that
of the benign tumour by necrosis and
haemorrhage.
Histopathology
Microscopically, the cellular features and
Fig. 4.75 Sclerosing type of Sertoli cell tumour.
growth patterns are similar to those of the
benign counterpart but tend to be more
variable within the same tumour and
between tumours. The solid, sheet-like
growth pattern is often prominent. The
nuclei may be pleomorphic with one or
more nucleoli, which are usually not very
prominent. Mitotic figures may be numerous,
and necrosis may occur. A fibrous,
hyalinized or myxoid stroma occurs in
varying amounts, but is usually sparse.
Lymphovascular invasion may be seen.
Lymphoplasmacytic infiltration is reported
in some cases varying from sparse to
pronounced and even with secondary
germinal centres.
The most important differential diagnoses
are classical and spermatocytic seminoma
and variants of yolk sac tumour, however
granulomatous reactions and
intratubular germ cell neoplasia are not
present in the surrounding testicular
parenchyma. Endometrioid adenocarcinoma
and metastases, and among the
latter especially adenocarcinomas with
pale or clear cytoplasm, as well as
melanoma should also be considered.
Immunohistochemical staining is helpful
in defining the Sertoli cell nature of the
tumour but not its malignant potential
{1074,1194}. The tumour cells are
cytokeratin and vimentin positive and
they may also be positive for epithelial
membrane antigen. They stain for inhibin
A, but usually not very intensely, and they
may be S100 positive. They are PLAP
and CEA negative.
Granulosa cell tumour group
Definition
Granulosa cell tumours of the testis are
morphologically similar to their ovarian
counterparts. Two variants are distinguished:
adult and juvenile types.
Fig. 4.76 Malignant Sertoli cell tumour.
A
Fig. 4.77 Malignant Sertoli cell tumour. A Solid and tubular components. B Vimentin staining in the tubular
component.
B
Sex cord / gonadal stromal tumours 255