Sertoli cell tumor of the testis

Sertoli cell tumors of the testis are uncommon sex cord stromal tumors. They are less common than Leydig cell tumors of the testis. 

Epidemiology

May present in both pediatric and adult males, depending on the histologic subtype.

Clinical presentation

Testicular mass or firmness. May occasionally present with precocious pseudopuberty or gynecomastia.

Pathology

Can occur in four histologic types:

• large-cell calcifying (pediatric)
• intratubular large cell hyalinizing Sertoli cell neoplasia (LCCSCT)
  • associated with pediatric males with Peutz-Jegher syndrome
• sclerosing Sertoli cell tumor (adults)
• Sertoli cell, not otherwise specified

Sertoli cell tumors are less likely to be hormonally active (aromatase) than Leydig cell tumors.

Sertoli cell tumors of the testis are associated with the Carney complex.

Radiographic features

Ultrasound

• ill-defined hypoechoic intratesticular lesion
• usually solitary, unless part of a syndrome
  • large cell subtype may present with multiple and bilateral mass with large areas of calcification

MRI

• limited characterization in the literature, nonspecific appearance
• T2: ​homogeneously hypointense
• T1 C+ (Gd)​: homogeneous enhancement

Treatment and prognosis

Unfortunately, although most are benign, the ultrasound appearance overlaps with malignancy, and the majority are diagnosed after orchiectomy.

There are a few case reports of malignant Sertoli cell tumors, but the majority appear benign. There are no known cases of malignant LCCSCT ², but data is limited.