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and Literature Review
Intratesticular Sertoli Cell Tumor: About A Case
and Literature Review
Tarik Mhanna1,2*, Anaour El Moudane1, Ali Barki1 and Ciprian Frasinescu2
1Department of Urology, Mohammed the first University Oujda, Morocco
2 Service de Chirurgie Urologique, France
Submission: November 4, 2019; Published:November 11, 2019
*Corresponding author:Tarik Mhanna, Department of urology, Mohammed IV university medical center, bp 60050 oujda, Morocco
How to cite this article:Tarik Mhanna, Anaour El Moudane, Ali Barki, Ciprian Frasinescu. Intratesticular Sertoli Cell Tumor: About A Case and Literature
Review. Glob J Reprod Med. 2019; 7(2): 5556709. DOI: 10.19080/GJORM.2019.07.555709.
Sertoli cell tumors (SCT) are very rare testicular tumors, representing 0.4% to 1.5% of all testicular malignancies. They are subclassified as classic, large-cell calcifying, and sclerosing Sertoli cell tumors. We report a case of a Sertoli cell tumor of the testis in a 37-year-old man. His chief complaint was a testicular pain right, that he had for 4 months. Serum levels of tumor markers were within normal limits. Radical orchiectomy was performed. Histopathology showed a Sertoli cell tumor with no evidence of malignancy. Through the observation and review of the literature which we will discuss the clinical and therapeutic features of this rare entity.
Tumours of the stroma and testicular sex cords account for 3-4% of all testicular tumours. Within this group, Sertoli cell tumours make up less than 1% of testicular tumours . Only 10% of these tumours are metastatic and are considered
malignant. They can be found at any age, but with a spike in frequency between 30 and 40 years. They occur in 40% of cases in a dysgenetic context . The most common clinical finding is a painless scrotal mass, with a third of the cases associated with gynecomastia and hormonal imbalance.
We report the case of a 37-year-old patient, who was admitted
to our structure for treatment of right testicular pain that has been
evolving for 4 months. The patient’s history mainly included sickle
cell disease. Clinical examination revealed a left testicle of normal
consistency, a straight testis increased in volume without palpable
nodules but of much firmer consistency than on the left. The
scrotal ultrasound revealed this right intra-testicular tissue lesion,
of regular contours, occupying almost the whole of the testicular
parenchyma, measuring in its large dimensions 33.4 X 17 mm
(Figure 1), This nodule is vascularized on the periphery and in the
center (Figure 2). Left testicle and epididymis of strictly normal
ultrasound appearance. Tumor biomarkers (αFP, βHCG, and LDH)
were normal. We decided to do a thoraco abdominal CT that does
not find metastasis at a distance, and two sperm samples for selfpreservation
at the CECOS level. Faced with these elements a right
inguinal orchidectomy after clamping first cord was performed.
The postoperative course was simple.
The macroscopic anatomo-pathological examination showed
a piece of orchiectomy comprising a cord and a testicle of 4.5 x 3.5
x 2 cm. At the cut, the testicular parenchyma contains a yellowish
solid lesion discretely lobulated without necrotic or haemorrhagic
reworking. This lesion, although limited, measures 2.8 x 2.1 cm
and does not macroscopically infiltrate the epididymis, the tunica
albuginea or the testile hilum. On microscopic examination it is
a proliferation of diffuse architecture, lobulated or trabecular.
This lesion consists of cubo-cylindrical cells with eosinophilic
cytoplasm containing an oval nucleus, sometimes a little irregular,
with a fine chromatin, without a prominent nucleolus. There are
some nuclear atypias and rare mitoses. From the topographic
point of view, the well-limited tumor is unencapsulated remaining
of strictly intra-testicular localization. The excision limits are
healthy. The immune labelings revealed reveal that the tumor
cells express an intense labeling for calretinin and vimentin.
Presence of a more discreet marking for Melan A. Proliferation
index Ki 67: 5%. In view of these aspects, the histological aspect
and the immunohistochemical profile evoke a Sertoli cell tumor.
The patient’s file was discussed in the multidisciplinary oncology
consultation, the decision was to perform simple monitoring.
Gonadal stromal cells and sex cords are derived embryologically
from the genital crest . There are different types of Sertoli
cell tumors: Variant without further indication, sclerosing, high
in lipids, large calcifying cells and malignant Sertoli tumors .
Sertoli cell tumors usually occur in post-pubertal subjects, mean
age 45 years at the time of diagnosis . But can occur at any age,
including neonates. Although the development of most SCT occurs
at normal testicle level, there are reported cases on cryptorchidic
testicles . SCT is usually sporadic but can occur in a dysgenetic
context such as:
a) The Carney complex, of autosomal dominant inheritance
(PRKAR1 gene mutation), which variable associates cutaneous
lentiginosis, myxomas, adrenocortical hyperplasia, pituitary
b) Peutz-Jeghers syndrome, of autosomal dominant
inheritance (LKB1 / STK11 tumor suppressor gene mutation)
involving cutanomucous lentiginosis, gastrointestinal
hamartomatous polyps and increased susceptibility to
c) Androgen insensitivity syndrome .
The most common clinical manifestation in SCT is the slow
and progressive development of painless testicular mass. About
one-third of the tumors in Sertoli cells are associated with gynecomastia, explained by the production of estrogens by tumor
cells, but it is not clear that estrogen is produced by Sertoli cells
or stromal cells . In children, we can also see early pseudopuberty.
From the anatomopathological point of view, the SCT
presents itself Macroscopically in the form of a nodular mass,
uniform or multifocal with a very limited appearance, firm and
solid of whitish grey colour. Microscopically: In well-differentiated
tumors, SERTOLI cells are arranged in tubules separated by a
fibrous stroma. The cells are arranged perpendicular to the axis
of the tube. They have a cytoplasmic vacuolization realizing a
micro-cystic aspect. For its less differentiated forms, histological
diagnosis can be difficult. One of the main criteria for the
histological diagnosis of SCT is the ability of Sertoli cells to form
tubes. From a phenotypic point of view, TCS show a marking with
anti-cytokeratin antibodies, vimentine, EMA (epithelial antigen
membrane) and sometimes NSE (neuron specific enolase) The
main histological differential diagnosis is represented by Leydig
cell tumors, which also derive from sex cords and therefore have
close architectural and cytological characteristics. A large tumor,
irregular margins, adjacent tissue invasion, lymphatic or vascular
invasion and mitotic patterns usually indicate a malignant tumor
of Sertoli cells, but the presence of metastasis is essential to prove
that a tumor is clinically malignant [5,6].
Metastases can be late and have a morphology different from
the initial tumor (better or worse differentiation than the initial
tumor) making their diagnosis sometimes difficult. They are
ganglionic, retroperitoneal and visceral (lung, liver, bone) [7,8].
Young et al,  in their 3.8-year average follow-up of 16 patients
with Sertoli cell tumors after radical orchiectomy; three of 12
patients who did not have metastases initially had metastases
late. Histologically, two of these three patients had microvascular
invasion, two with nuclear pleomorphism and necrosis in one
patient. The prognosis for a benign form of SCT is good, but the
prognosis for malignant forms has not been well established.
Metastatic tumors of Sertoli cells have a poor prognosis; Godec
 reported an average survival of 15 months after Diagnosis of
metastasis in nine patients. The last cases of metastases reported
in the literature occurred 10 years after a radical orchidectomy
. Kolon et al,  suggested that a 5-year follow-up is necessary
because of the characteristics of the tumor. In our case, we think
that the prognosis of our patient will be good because of the small
size of the mass, absence of histological abnormalities indicative
of malignancy, and absence of evidence of metastatic localization.
But close monitoring will be needed to detect late metastases.
Therapeutic management Repose on orchiectomy in benign
forms, an enucleation could be considered. Complete excision
of the lesion is necessary to establish the diagnosis. In bilateral
forms, unilateral orchiectomy with contralateral partial surgery is
proposed. Retroperitoneal curettage is poorly documented in the
literature. Lindegaard  on a series of 21 metastatic SCT reports
5 lesions. Radiation therapy has not been proven effective in SCT.
Chemotherapy in metastatic SCT situations is not standardized,
it relies on Cisplatin-based protocols by analogy with tumors of
Stromal Sertoli cell tumors and sex cords are rare. Malignancy,
although exceptional, should be considered whenever there is
a large tumor (greater than 5 cm) associated with cytonuclear
polymorphism and significant mitotic activity. Orchiectomy is the
treatment of choice.
Written informed consent was obtained from the patient’s next
of kin for publication of this case report and any accompanying
images. A copy of the written consent is available for review by the
Editor-in-Chief of this journal.
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