Young R H, Koelliker D D, Scully R E
The James Homer Wright Pathology Laboratories of the Massachusetts General Hospital, Harvard Medical School, Boston 02114, USA.
Am J Surg Pathol. 1998 Jun;22(6):709-21. doi: 10.1097/00000478-199806000-00008.
Sixty Sertoli cell tumors of the testis, excluding large cell calcifying and sclerosing subtypes, are described. Patient age ranged from 15 to 80 years (mean, 45 years). The initial manifestation was usually a testicular mass; in 14 cases it had been enlarging slowly for a period of up to 14 years (mean 3.7 years). Only five patients had testicular pain. Four patients had metastatic disease at the time of presentation. All the tumors were unilateral and ranged from 0.3 cm to 15 cm (mean 3.6 cm). They were typically well circumscribed. Sectioning usually disclosed firm, tan-gray, white, or yellow tissue with areas of hemorrhage and a minor cystic component in approximately one third. Microscopic evaluation usually revealed diffuse sheets or large, nodular aggregates of tumor cells, within which solid or hollow, sometimes dilated, tubules and, less often, cords were usually at least focally identifiable. A relatively acellular, often vascular, fibrous to hyalinized stroma was frequently conspicuous. The tumor cells typically had moderate amounts of pale to lightly eosinophilic cytoplasm, but 10 tumors had cells with abundant eosinophilic cytoplasm. Large cytoplasmic vacuoles were prominent in 26 tumors. Nuclear atypicality was absent or mild in 54 cases, moderate in 4 cases, and marked in 2 cases. Mitotic rate ranged from less than 1 to 21 per 10 high power fields, with 50 tumors having no or only rare mitoses. Vascular space invasion was present in 11 cases and was prominent in 8. Follow-up of more than five years (average 8.4 years), or until evidence of metastasis was seen, was available for 16 patients. Nine were alive and well with no evidence of disease. Four were alive with disease and three died of disease. The pathologic features that best correlated with a clinically malignant course were as follows: a tumor diameter of 5.0 cm or greater, necrosis, moderate to severe nuclear atypia, vascular invasion and a mitotic rate of more than 5 mitoses per 10 high power fields. Only one of nine benign tumors for which follow-up data of 5 years or more were available had more than one of these features, whereas five of seven malignant tumors had at least three.
本文描述了60例睾丸支持细胞瘤，不包括大细胞钙化型和硬化型亚型。患者年龄在15岁至80岁之间（平均45岁）。最初的表现通常是睾丸肿块；14例患者中，肿块缓慢增大达14年之久（平均3.7年）。只有5例患者有睾丸疼痛。4例患者在就诊时已有转移。所有肿瘤均为单侧，大小从0.3 cm至15 cm不等（平均3.6 cm）。它们通常边界清晰。切片通常显示质地坚实，呈棕灰色、白色或黄色，约三分之一的组织有出血区和少量囊性成分。显微镜下评估通常显示肿瘤细胞呈弥漫性片状或大的结节状聚集，其中实性或中空、有时扩张的小管以及较少见的条索通常至少在局部可见。相对无细胞、常为血管性、纤维性至玻璃样变的间质常很明显。肿瘤细胞通常有中等量的淡染至轻度嗜酸性细胞质，但10例肿瘤的细胞有丰富的嗜酸性细胞质。26例肿瘤中有明显的大细胞质空泡。54例细胞核异型性无或轻微，4例中等，2例明显。有丝分裂率为每10个高倍视野少于1至21个，50例肿瘤无或仅有罕见的有丝分裂。11例有血管间隙侵犯，8例明显。16例患者有超过5年（平均8.4年）的随访，或直至出现转移证据。9例存活且情况良好，无疾病证据。4例带瘤存活，3例死于疾病。与临床恶性病程最相关的病理特征如下：肿瘤直径5.0 cm或更大、坏死、中度至重度细胞核异型性、血管侵犯以及每10个高倍视野有丝分裂率超过5个。在有5年或更长时间随访数据的9例良性肿瘤中，只有1例有上述特征中的一项以上，而7例恶性肿瘤中有5例至少有三项。
