睾丸支持细胞瘤8例临床病理观察
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摘要
目的探讨睾丸支持细胞瘤的临床及病理组织学特征、诊断及鉴别诊断。方法收集8例睾丸支持细胞瘤,进行形态学及免疫组化检测,并对相关文献复习。结果 8例支持细胞瘤患者中7例为男性,1例为假两性畸形;年龄10～54岁,中位年龄28.5岁;肿瘤直径1～6.5 cm,平均3.1 cm。6例为正常下降的睾丸,1例为合并假两性畸形的睾丸,1例为隐睾;1例合并乳腺发育,余7例无明显内分泌症状。镜下,7例为非特殊型支持细胞瘤,肿瘤细胞呈小梁状、实性巢状、中空小管状排列,肿瘤细胞圆形、卵圆形或多角形,部分胞质内有空泡,轻度异性,可见核沟及核仁,偶见核分裂象。部分病例可见纤维玻璃样变背景中相互吻合的小管和条索。1例为大细胞钙化性支持细胞瘤,肿瘤细胞呈实性巢片状,肿瘤内及管状结构内均可见大片状不规则颗粒状钙化灶,灶状区域间质疏松黏液样变,淋巴细胞浸润;局部可见灶状坏死,周围曲细精管内可见原位支持细胞砂砾体样钙化的证据。免疫组化显示肿瘤细胞Calretinin、α-inhibin、vimentin、WT-1(+),AE1/AE3灶状(+),PLAP、EMA、SMA、CD117、AR、CD56、SALL、CK8/18、D2-40、CK5/6、SALL4、Oct3/4(-),钙化性大细胞支持细胞瘤S-100(+)。6例获得随访,均无复发及转移。结论睾丸支持细胞瘤是一种具有恶性潜能的交界性肿瘤,应与间质细胞瘤、精原细胞瘤、间皮瘤、腺瘤样瘤、隐睾中的支持细胞结节、支持细胞增生等鉴别。
Objective To investigate the clinical manifeststions and histopathological features of testicular sertoli cell tumor. Methods A total of 8 cases of sertoli cell tumor were collected for morphological and immunohistochemical detection, and related literatures were reviewed. Results Seven cases of sertoli cell tumors were males, and one was a pseudohermaphroditism, aged 10～54 years, with median age of 28.5 years; tumor diameter was 1.0～6.5 cm, with average 3.1 cm, and 1 case presented with pseudohermaphroditism testis, 1 case of cryptorchidism, and 6 cases of normal testis; 1 case presented with mammary gland development; 7 cases showed no endocrine symptoms; 7 cases were non-specific sertoli cell tumor. Tumor cells were trabecular, solid nested, hollow tubular arrangement; tumor cells were round, oval or polygonal, some vacuoles in the cytoplasm; slightly heterosexual, nuclear groove and nucleoli were noted, occasionally with mitotic figures. In some cases the anastomosed tubules and sheets were present in the glassy background. One case was a large cell calcification sertoli cell tumor, solid large-scale irregular granular calcifications were found in the nested tumors and in the tubular structure. The focal region was loose and mucinous, and lymphocyte infiltration was observed. Localized focal necrosis was seen. Evidence of sand-like calcification of in situ sertoli cells can be seen in the surrounding seminiferous tubules. Immunohistochemical markers showed that the tumor cells were Calretinin(+), α-inhibin(+), vimentin(+), AE1/AE3(+), WT-1(+), S-100(+), PLAP(-), EMA(-), SMA(-), CD117(-), AR(-), CD56(-), SALL(-), CK8/18(-), D2-40(-), CK5/6(-), SALL4(-), Oct3/4(-). 2 cases was lost to follow-up, the other 6 patients had no recurrence or metastasis when follow-up from 4 to 72 weeks. Conclusions Sertoli cell tumor is borderline tumors with malignant potential. It should be distinguished from stromal cell tumors, seminoma, mesothelioma, adenomatoid tumors, sertoli cell nodules in cryptorchidism, and sertoli cell proliferation.
Objective To investigate the clinical manifeststions and histopathological features of testicular sertoli cell tumor. Methods A total of 8 cases of sertoli cell tumor were collected for morphological and immunohistochemical detection, and related literatures were reviewed. Results Seven cases of sertoli cell tumors were males, and one was a pseudohermaphroditism, aged 10～54 years, with median age of 28.5 years; tumor diameter was 1.0～6.5 cm, with average 3.1 cm, and 1 case presented with pseudohermaphroditism testis, 1 case of cryptorchidism, and 6 cases of normal testis; 1 case presented with mammary gland development; 7 cases showed no endocrine symptoms; 7 cases were non-specific sertoli cell tumor. Tumor cells were trabecular, solid nested, hollow tubular arrangement; tumor cells were round, oval or polygonal, some vacuoles in the cytoplasm; slightly heterosexual, nuclear groove and nucleoli were noted, occasionally with mitotic figures. In some cases the anastomosed tubules and sheets were present in the glassy background. One case was a large cell calcification sertoli cell tumor, solid large-scale irregular granular calcifications were found in the nested tumors and in the tubular structure. The focal region was loose and mucinous, and lymphocyte infiltration was observed. Localized focal necrosis was seen. Evidence of sand-like calcification of in situ sertoli cells can be seen in the surrounding seminiferous tubules. Immunohistochemical markers showed that the tumor cells were Calretinin(+), α-inhibin(+), vimentin(+), AE1/AE3(+), WT-1(+), S-100(+), PLAP(-), EMA(-), SMA(-), CD117(-), AR(-), CD56(-), SALL(-), CK8/18(-), D2-40(-), CK5/6(-), SALL4(-), Oct3/4(-). 2 cases was lost to follow-up, the other 6 patients had no recurrence or metastasis when follow-up from 4 to 72 weeks. Conclusions Sertoli cell tumor is borderline tumors with malignant potential. It should be distinguished from stromal cell tumors, seminoma, mesothelioma, adenomatoid tumors, sertoli cell nodules in cryptorchidism, and sertoli cell proliferation.
引文
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[2] Gourgari E, Saloustros E, Stratakis CA. Large-cell calcifying sertoli cell tumors of the testes in pediatrics [J]. Curr Opin Pediatr, 2012, 24(4): 518-522.
[3] Lai JP, Lee CC, Crocker M, et al. Isolated large cell calcifying sertoli cell tumor in a young boy, not associated with peutz-jeghers syndrome or carney complex [J].Ann Clin Lab Res, 2015, 3(1): 2.
[4] Zhang C, Ulbright TM. Nuclear localization of β-Catenin in sertoli cell tumors and other sex cord-stromal tumors of the testis: an Immunohistochemical study of 87 cases [J]. Am J Surgi Pathol, 2015, 39(10): 1390-1394.
[5] Pradipta G,Debasis Sarkar,Arindam Ray, et al. Malignant large cell calcifying sertoli cell tumor of testis with skip metastasis to lung presented with peutzJeghers syndrome[J]. Tanaffos, 2012, 11(4): 63-68.
[6] Li G, Lee MS, Kraft KH, et al. Prepubertal malignant large cell calcifying sertoli cell tumor of the testis [J]. Urology, 2018, 117: 145-149.
[7] Kratzer SS, Ulbright TM, Talerman A, et al. Large cell calcifying sertoli cell tumor of the testis: contrasting features of six malignant and six benign tumors and a review of the literature [J]. Am J Surg Pathol, 1997, 21(11): 1271-1280.
[8] Tanaka Y,Carney JA, Ijiri R, et al. Utility of immunostaining for S-100 protein subunits in gonadal sex cord-stromal tumors, with emphasis on the large-cell calcifying Sertoli cell tumor of the testis [J]. Human Pathology, 2002, 33(3):285-289.
[2] Gourgari E, Saloustros E, Stratakis CA. Large-cell calcifying sertoli cell tumors of the testes in pediatrics [J]. Curr Opin Pediatr, 2012, 24(4): 518-522.
[3] Lai JP, Lee CC, Crocker M, et al. Isolated large cell calcifying sertoli cell tumor in a young boy, not associated with peutz-jeghers syndrome or carney complex [J].Ann Clin Lab Res, 2015, 3(1): 2.
[4] Zhang C, Ulbright TM. Nuclear localization of β-Catenin in sertoli cell tumors and other sex cord-stromal tumors of the testis: an Immunohistochemical study of 87 cases [J]. Am J Surgi Pathol, 2015, 39(10): 1390-1394.
[5] Pradipta G,Debasis Sarkar,Arindam Ray, et al. Malignant large cell calcifying sertoli cell tumor of testis with skip metastasis to lung presented with peutzJeghers syndrome[J]. Tanaffos, 2012, 11(4): 63-68.
[6] Li G, Lee MS, Kraft KH, et al. Prepubertal malignant large cell calcifying sertoli cell tumor of the testis [J]. Urology, 2018, 117: 145-149.
[7] Kratzer SS, Ulbright TM, Talerman A, et al. Large cell calcifying sertoli cell tumor of the testis: contrasting features of six malignant and six benign tumors and a review of the literature [J]. Am J Surg Pathol, 1997, 21(11): 1271-1280.
[8] Tanaka Y,Carney JA, Ijiri R, et al. Utility of immunostaining for S-100 protein subunits in gonadal sex cord-stromal tumors, with emphasis on the large-cell calcifying Sertoli cell tumor of the testis [J]. Human Pathology, 2002, 33(3):285-289.