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Sertoli-Cell Tumor of the Testis

Definition

The Sertoli-cell tumor is a rare stromal tumor of the testis with the proliferation of Sertoli cells and the possibility of hormone production (Loy and Linke, 2003).

Epidemiology

1% of all testicular tumors, they occur in 30% before puberty.

Pathology of the Sertoli-cell Tumor

Sertoli-cell tumor are usually small, yellow-brown, and sharply circumscribed in the testicular tissue. There is a variable predominance of epithelial-like (Sertoli cells) or stromal-like proliferation. The histological criteria for malignancy, which occurs in 10% of cases, are poorly defined.

Signs and Symptoms

• Nontender palpable testicular tumor
• Hormonal symptoms (e.g., gynecomastia due to estrogen secretion) are not typical but possible.

Diagnostic Workup

Laboratory tests

Laboratory tests:

For differential diagnosis of gynecomastia: Testosterone estrogen, LH, FSH, and prolactin. Tumor markers of germ cell tumors (AFP, HCG, and LDH) are within the normal range.

Ultrasound of the testes:

Testicular ultrasound imaging shows a well-circumscribed hypoechoic testicular mass; calcifications may be visible.

Staging:

If malignancy is possible, perform a CT scan of the chest and abdomen.

Treatment of Sertoli-cell Tumor

Surgical treatment

Inguinal radical orchiectomy is often the initial treatment for larger tumors. Testis-sparing surgery is possible for small tumors or if a benign tumor is suspected: after enucleation, the tumor is sent for a frozen section. If malignancy is suspected (germ cell tumor or malignant Sertoli-cell tumor), proceed with radical orchiectomy.

Retroperitoneal lymphadenectomy:

Offer (laparoscopic) retroperitoneal lymphadenectomy if pathology shows clear signs of malignancy or if enlarged retroperitoneal lymph nodes are present.

Chemotherapy:

Chemotherapy for metastatic Sertoli-cell tumors; however, the response rates are low with cisplatin-containing combination regimens.

References

Loy und Linke 2003 LOY, V. ; LINKE, J.: [Endocrine tumors of the testis].
In: Pathologe
24 (2003), Nr. 4, S. 308–13

  Deutsche Version: Sertoli-Zell Tumor des Hodens