Anitha Chalageri

Anjana Gupta

Manjula Vijayanand

Srinivas Ghante Nagaraj

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149
IRANIAN JOURNAL OF PATHOLOGYVol.9 No.2, Spring 2014 
Case Report
Sclerosing Sertoli Cell Tumor of the Testis:
 Case Report and Review of the Literature
Srinivas Ghante Nagaraj, Anitha Chalageri, Manjula Vijayanand, Anjana Gupta
Dept. of Pathology, SRL DIAGNOSTICS - KCDC, Mysore, India
ABSTRACT
Sertoli cell tumors of the testis are extremely rare tumors with a heterogeneous pathology. Three 
histological variants have been described: Sertoli cell tumor not otherwise specified (NOS), large 
cell calcifying sertoli cell tumor and the Sclerosing Sertoli cell tumor. The sclerosing Sertoli cell 
tumor described herein is associated with prominent stromal sclerosis. They present as painless 
scrotal masses without hormonal disturbances and are benign in nature. Less than 30 cases have 
been reported in the world literature. We present a case of Sclerosing Sertoli cell tumor in a 39 
year old male patient who presented with the complaints of a slowly growing painless mass in the 
right testicular region for 4 years.
Keywords: Sertoli Cell Tumor, Testis, Case Report, India
Received: 05 March 2013
Accepted: 15 July 2013
Address Communication to: Dr. Anitha Chalageri, Department of Pathology, SRL DIAGNOSTICS -KCDC,Mysore, India.
Email: anitha.chalageri@gmail.com
Iranian Journal of Pathology (2014) 9 (2), 149 - 51
Introduction
Sex cord-stromal tumors of the testis are rare and most of them come under the “unclassified” category (1).“Sertoli cell 
tumors of the testis are extremely rare accounting 
for 0.4-1.5% of all testicular neoplasms (2)”. 
These tumors have a heterogeneous pathology 
(1, 2). Histopathologically three variants have 
been described: classic (Not otherwise specified), 
large cell calcifying and sclerosing subtypes (2, 
3). These subtypes need to be differentiated as 
they differ in particular in age of onset, malignant 
potential, prognosis, and treatment modality 
(2).The rare sclerosing variant described 
herein is a hypocellular tumor with  prominent 
stromal sclerosis and no necrosis or vascular or 
lymphatic invasion. Dense sclerotic stroma and 
hypocellularity make the diagnosis on fine needle 
aspiration difficult as repeated aspirations yield 
very scanty material. It has a benign behavior 
and till date, no malignant cases of sclerosing 
Sertoli cell tumor have been reported. “Both 
other subtypes have been found to be potentially 
malignant” (2).  Malignant cases have very poor 
prognosis and it is difficult to treat successfully 
because of the very little experience available 
with these tumors (2). Once the Sertoli cell tumor 
150
Vol.9 No.2, Spring 2014 IRANIAN JOURNAL OF PATHOLOGY
has been diagnosed, histological subtyping is 
necessary as the treatment modality varies. To 
date, less than 30 cases have been reported (3-
12). 
We present a case of Sclerosing sertoli cell tumor 
in a 39 year old male patient who presented with 
the complaints of a slowly growing painless mass 
in the right testicular region for 4 years.
Case Report 
A 39 year old man presented with a mass in the 
right testicular region that had been present for 
4 years. Tumor markers for testicular cancer 
such as Beta – Human B and H to capital letters 
Chorionic Gonadotropin and Alpha Feto Protein 
levels were not elevated. Repeated fine needle 
aspiration yielded very scanty material and 
showed only few spindled cells which no opinion 
was possible. There was no evidence of estrogen 
production by the tumor. High orchidectomy 
was done and the specimen was sent to us for 
histopathological examination.
Gross examination showed a well circumscribed 
hard nodular mass measuring 5.5×3.5cm. Cut 
surface was yellowish white and homogeneous. 
Normal testicular tissue was not identified (Fig. 1).
Microscopy showed sertoli cells arranged in 
few thin cords, few small tubules and occa-
sional large irregular aggregates in a prominent 
fibrocollagenous stroma. The tumor cells had a 
moderate amount of pale cytoplasm and round, 
bland and uniform nuclei. No invasion was seen. 
No necrosis and mitosis were seen. The nucleoli 
were not prominent. The stroma was fibrotic and 
moderately cellular and hyalinised with few di-
lated blood vessels (Fig. 2 & 3).
A diagnosis of Sclerosing Sertoli Cell Tumor was 
made.
Discussion
Sex – cord – gonadal stromal neoplasms of the 
testes account for approximately 5% of testicular 
tumors, and most of them are Leydig cell tumors 
(2, 12). “Pure Sertoli cell testicular tumors are 
uncommon and account for approximately 1% 
of testicular tumors (2)”. “These tumors, usu-
ally considered benign, are a heterogenous entity 
because of their histological and clinical vari-
ability” (2,3,12). They are classified according 
to their histological characteristics into the fol-
lowing subtypes, classic (Not Otherwise Speci-
fied), Large cell calcifying variant and sclerosing 
variant (2, 3, 6). Sclerosing sertoli cell tumor was 
described by Zukerberg et al. in a review of ap-
proximately 200 cases of sex – cord – stromal 
tumors of the testis (1). In their series the scleros-
ing variant was observed in 10 cases (1). To date, 
less than 30 cases have been reported (1-12).
The sclerosing sertoli cell tumor is a hypocel-
lular variant with diffuse stromal sclerosis and 
no necrosis or vascular or lymphatic invasion 
(1,12). While they can occur at any age, the peak 
incidence is between 35 and 50 years (1,7,12). 
In our case the patient was 39 years old. “These 
tumors are usually asymptomatic, small (0.5 – 2 
cm, rarely measuring more than 5.0 cm in their 
longest diameter), well delimited, white or gray 
with a solid surface” (1,12). However in our case 
the tumor measured 5.5 cm in the longest diam-
eter, probably because of the long duration of the 
swelling. Microscopically, features of Scleros-
ing Sertoli Cell Tumor include small neoplastic 
tubules surrounded by a dense sclerotic stroma. 
These tumors characteristically have small solid 
cords, anastomosing tubules and thin cords of 
Sertoli cells in a prominent fibrous sclerosing 
stroma with thick collagenous bands (1,12). Our 
case showed sertoli cells arranged in thin cords, 
few simple tubules, and occasional large irregu-
lar aggregates in a prominent fibrocollagenous 
stroma. “The Sertoli cells are small to medium 
size with pale cytoplasm and occasional large 
lipid vacuoles” (1). The nuclei are typically 
bland. There are usually no mitotic figures but 
atypia is rarely seen (1). The fibrous stroma may 
entrap non-neoplastic tubules, resembling im-
mature tubules in Sertoli cell nodules of crypt-
Sclerosing Sertoli Cell Tumor of the Testis: Case Report and ...
151
IRANIAN JOURNAL OF PATHOLOGYVol.9 No.2, Spring 2014 
Srinivas Ghante Nagaraj, et al.
orchid testes (1,12). The tubules may be discrete 
or anastomosing and may be solid or hollow 
(1,12). Similar microscopic features were seen in 
our case also. The sclerosing variant is unilateral 
and affects either testis at the same rate unlike 
the large cell calcifying variant which can be bi-
lateral and multifocal (12).“In general, approxi-
mately 25% of sertoli cell tumors have estrogen 
producing activity as gynecomastia, and this fea-
ture is absent in the sclerosing variant (12)”. Our 
case also did not show any estrogen producing 
activity. To date, no recurrent or metastatic cases 
have been reported (2). The differential diagnosis 
includes adenomatoid tumor (usually paratestic-
ular, no prominent fibrosis) and metastatic carci-
noma (marked atypia). Currently, in the absence 
of radiologic signs of invasion of lymph nodes 
or distant metastasis, radical orchidectomy is the 
recommended treatment.
Here we presented a case of Sclerosing sertoli 
cell tumor in a 39 year old male patient who pre-
sented with the complaints of a slowly growing 
painless mass in the right testicular region for 4 
years. The sclerosing Sertoli cell tumor described 
above is associated with prominent stromal scle-
rosis. Although these tumors are usually benign, 
a long-term follow-up is recommended. 
Acknowledgements
The authors declare that there is no conflict of 
interest.
 
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Case Report Sclerosing Sertoli Cell Tumor of the Testis: Case Report and Review of the Literature

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Case Report Sclerosing Sertoli Cell Tumor of the Testis: Case Report and Review of the Literature

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