Kratzer S S, Ulbright T M, Talerman A, Srigley J R, Roth L M, Wahle G R, Moussa M, Stephens J K, Millos A, Young R H
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, USA.
Am J Surg Pathol. 1997 Nov;21(11):1271-80. doi: 10.1097/00000478-199711000-00002.
We report six malignant and six benign large cell calcifying Sertoli cell tumors of the testis and compare the features of malignant and benign cases based on these cases and those in the literature. All the tumors in this report consisted of sheets, nests, solid tubules, and cords of eosinophilic cells, with focal calcifications, as well as a substantial neutrophilic infiltrate in 11 of them. Analysis of our cases and those in the literature showed that the malignant tumors were unilateral and solitary and occurred at a mean age of 39 years (range 28-51 years), whereas the benign neoplasms were bilateral and multifocal in 28% of cases and occurred at a mean age of 17 years (range 2-38 years). Only one malignant tumor occurred in a patient with evidence of a genetic syndrome (Carney syndrome), whereas 36% of benign tumors had various genetic syndromes or endocrine abnormalities. Most of the tumors in the latter cases were bilateral and multifocal. There were strong associations of malignant behavior with size >4 cm, extratesticular growth, gross or microscopic necrosis, high-grade cytologic atypia, vascular space invasion, and mitotic rate greater than three mitoses per 10 high-power fields. All malignant cases exhibited at least two of these features, whereas all benign cases lacked any of them. The presence of any one of these features in a solitary large cell calcifying Sertoli cell tumor, especially in a patient >25 years of age, should be viewed as suspicious for malignant behavior, whereas the presence of two or more of these features indicates a strong probability of a malignant course. "Low" percentages (< or =35%) of tumor cells staining for proliferating cell nuclear antigen (PCNA) also may correlate with benign behavior, but some benign tumors have high PCNA values. Ki-67 values (MIB-1 antibody) did not correlate with biologic behavior, nor did immunostains for p53 protein.
我们报告了6例睾丸恶性大细胞钙化性支持细胞瘤和6例良性大细胞钙化性支持细胞瘤，并根据这些病例以及文献中的病例，比较恶性和良性病例的特征。本报告中的所有肿瘤均由嗜酸性细胞的片状、巢状、实体小管和条索组成，伴有局灶性钙化，其中11例有大量中性粒细胞浸润。对我们的病例以及文献中的病例分析显示，恶性肿瘤为单侧单发，平均发病年龄为39岁（范围28 - 51岁），而良性肿瘤28%为双侧多发，平均发病年龄为17岁（范围2 - 38岁）。仅有1例恶性肿瘤发生于有遗传综合征（卡尼综合征）证据的患者，而36%的良性肿瘤有各种遗传综合征或内分泌异常。后一类病例中的大多数肿瘤为双侧多发。恶性行为与肿瘤大小>4 cm、睾丸外生长、大体或镜下坏死、高级别细胞学异型性、血管腔侵犯以及每10个高倍视野有超过3个有丝分裂相关。所有恶性病例均至少具备这些特征中的两项，而所有良性病例均不具备其中任何一项。孤立性大细胞钙化性支持细胞瘤中出现这些特征中的任何一项，尤其是在年龄>25岁的患者中，应视为恶性行为可疑，而出现两项或更多这些特征则提示恶性病程的可能性很大。增殖细胞核抗原（PCNA）染色的肿瘤细胞“低”百分比（≤35%）也可能与良性行为相关，但一些良性肿瘤的PCNA值较高。Ki-67值（MIB-1抗体）与生物学行为无关，p53蛋白免疫染色也无关。
