Henley John D, Young Robert H, Ulbright Thomas M
Departments of Pathology, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Am J Surg Pathol. 2002 May;26(5):541-50. doi: 10.1097/00000478-200205000-00001.
The distinction of Sertoli cell tumors from seminoma is critical to ensure proper treatment. Although usually straightforward, we highlight herein 13 malignant Sertoli cell tumors of the testis with light microscopic features that mimicked seminoma. All of the cases were received in consultation, 10 with submitting diagnoses of seminoma, usually of classic type, but three cases of spermatocytic type. Patients ranged from 15 to 80 years of age (median 37 years); all presented with testicular masses. The tumors were typically firm, white to yellow-tan, and often had foci of hemorrhage. The dominant microscopic pattern was nested or sheet-like, with some tumors having secondary patterns of trabeculae-solid tubules, hollow tubules, and pseudofollicles. Tumor cells were polygonal with conspicuous clear cytoplasm in 12 cases; the cytoplasm was focally eosinophilic in 10 cases, but this was never conspicuous. Nine tumors had cytoplasmic vacuoles, and three of four that were investigated stained for intracytoplasmic glycogen. Nuclei were small (5) to medium-sized (8), round-to-oval (13), and vesicular with irregular contours (11). Nucleoli were present in 11 tumors (six small; five large). Stromal fibrosis (12) and lymphoid infiltrates (10) were conspicuous, and tumor necrosis (11) and vascular invasion (8) also were seen. Mitotic figures ranged from <1 to 21/10 high power fields (HPF) (median 1/10 HPF). Staining for inhibin-alpha, epithelial membrane antigen, and cytokeratin (AE1/AE3) was positive in four of four, six of six, and three of six cases, respectively; placental alkaline phosphatase was negative in all five tumors investigated. The nested growth pattern, prominence of clear cells, lymphoid infiltrate, inconspicuous tubular differentiation, cytoplasmic glycogen, and prominent nucleoli caused these tumors to be mistaken for seminomas. The smaller, less pleomorphic nuclei of Sertoli cell tumors, their lower mitotic rate, and the absence of intratubular germ cell neoplasia are helpful differential features. Immunohistochemistry is a useful adjunct in confirming the diagnosis of Sertoli cell tumor, but only if the overlapping features are appreciated by conventional microscopy and the diagnosis of Sertoli cell tumor included in the differential.
将睾丸支持细胞瘤与精原细胞瘤区分开来对于确保恰当治疗至关重要。尽管通常较为直接明了，但我们在此强调13例睾丸恶性支持细胞瘤，其光镜特征酷似精原细胞瘤。所有病例均为会诊病例，10例提交的诊断为精原细胞瘤，通常为经典型，但有3例为精母细胞型。患者年龄从15岁至80岁不等（中位年龄37岁）；均表现为睾丸肿块。肿瘤通常质地坚硬，呈白色至黄棕色，且常伴有出血灶。主要的显微镜下形态为巢状或片状，部分肿瘤具有小梁状实性小管、空心小管和假滤泡等继发性形态。12例肿瘤细胞呈多边形，胞质明显清亮；10例胞质局灶性嗜酸性，但不明显。9例肿瘤有胞质空泡，4例中3例检测显示胞质内有糖原染色。细胞核小（5例）至中等大小（8例），圆形至椭圆形（13例），核呈泡状，轮廓不规则（11例）。11例肿瘤有核仁（6例小核仁；5例大核仁）。间质纤维化（12例）和淋巴细胞浸润（10例）明显，肿瘤坏死（11例）和血管侵犯（8例）也可见到。有丝分裂象范围为每10个高倍视野<1至21个（中位值为每10个高倍视野1个）。抑制素α、上皮膜抗原和细胞角蛋白（AE1/AE3）染色分别在4例中的4例、6例中的6例和6例中的3例呈阳性；所检测的5例肿瘤中胎盘碱性磷酸酶均为阴性。巢状生长模式、透明细胞突出、淋巴细胞浸润、不明显的小管分化、胞质糖原和明显的核仁导致这些肿瘤被误诊为精原细胞瘤。支持细胞瘤细胞核较小、异型性较低、有丝分裂率较低以及不存在小管内生殖细胞肿瘤是有助于鉴别的特征。免疫组织化学在确诊支持细胞瘤方面是一种有用的辅助手段，但前提是传统显微镜能识别重叠特征且鉴别诊断中考虑到支持细胞瘤。
