Molecular-cytogenetic characterisation of sex cord-stromal tumours: CGH analysis in sertoli cell tumours of the testis

Sertoli cell tumours (SCT) are rare and poorly explored neoplasias, and the genetic features of these uncommon tumours are largely unknown. Data about chromosomal aberrations in human SCT of the testis are very rare. We present in this paper the first molecular-cytogenetic study of SCT of the testis. DNA was isolated from paraffin-embedded tumour material from 11 patients with unilateral SCT. We used comparative genomic hybridisation to investigate changes in DNA copy number. The detected DNA imbalances showed variation from case to case, indicating a high genetic heterogeneity. Chromosomal aberrations were detected in 9 of the 11 tumours evaluated, with 13 losses versus 14 gains. The most frequent aberrations detected were gain of chromosome X (5 of 11 cases) followed by losses of entire or part of chromosomes 2 and 19 in three cases. This study suggests a high variability in histomorphological and genetic patterns. Only gain of the entire chromosome X seems to be a frequent aberration in these tumours. Further studies of these tumour types are necessary to clarify the significance of chromosomal alterations in carcinogenesis of SCT.

[Clinicopathological study of primary carcinoid tumor of the testis]

OBJECTIVE

To study the clinicopathological characteristics, immunohistochemical features and histogenesis of primary testicular carcinoid tumor and its differential diagnosis.

METHODS

Light microscopy and immunohistochemical stains were performed in 4 cases of primary testicular carcinoid tumor.

RESULTS

The patients sought care for scrotum mass presented from 2 to 36 years, 2 cases accompanied with tender swelling of the testis. The tumors were described as nodular, yellowish-gray in color, 3.0-4.0 cm in the greatest dimensions, and well circumscribed, focal necrosis seen in 1 case. Histologically, they showed insular and trabecular patterns separated by fine fibrous bands. The tumor cells were round or polygonal with regular monomorphic nuclei, stippling chromatin and eosinophilic granular cytoplasm. There were rosette-like and tubuloglandular patterns with eosinophilic secretion in the cavity. Immunohistochemical staining for synaptophysin, chromogranin A, NSE and cytokeratin showed diffusely positive expression in the tumor cells.

CONCLUSION

Primary testicular carcinoid tumor is extremely rare with good prognosis and its histogenesis remains controversial. Diagnostically it has to be differentiated from seminoma, metastatic carcinoid tumor, Sertoli cell tumor and granulosa cell tumor.

Giant Sertoli cell nodule of the testis: distinction from other Sertoli cell lesions

The case of a 33-year-old man with a clinically suspected testicular neoplasm is reported here. The radical orchidectomy specimen showed a sharply demarcated, firm, yellow-white 1-cm nodule beneath the tunica albuginea at the upper pole. Microscopical examination showed the encapsulated nodule to be composed of tubules lined by immature Sertoli cells with interspersed spermatogonia and an interwoven network of hyalinised basement membrane having foci of calcification. Immunohistochemical studies verified the fetal phenotype of the Sertoli cells and the non-neoplastic nature of the germ cell component. Except for the large size, the findings were identical to those of a Sertoli cell nodule-a typically microscopic, unencapsulated lesion commonly detected in cryptorchid testes. The term "giant Sertoli cell nodule" is used for this unique, hitherto undescribed lesion and its distinction from other Sertoli cell lesions of the testis is considered here.

Sertoli-stromal cell tumor of the right ovary: radiological-pathological correlation

A case of Sertoli-stromal cell tumor of the right ovary is reported. The patient was a 50-year-old perimenopausal woman with abdominal distention due to a large pelvic tumor. She had no signs of androgen excess. A large solid sponge-like tumor with multicystic areas throughout, in which there were some small hemorrhagic spots, was shown on magnetic resonance (MR) imaging. No endometrial thickening of the uterus was seen. Pathology examination revealed a Sertoli-stromal cell tumor with intermediate-to-poor differentiation. The edematous, watery, sponge-like appearance on the MR images correlated with the pathological findings.

Extratesticular interstitial and Sertoli cell tumors in previously neutered dogs and cats: a report of 17 cases

Primary neoplasms derived from testicular tissue and in an extratesticular location are extremely rare. Clinical and surgical information was collected and verified from 15 different submitting practices for 12 dogs and 5 cats that spontaneously developed neoplasms of testicular origin after castration. Eleven dogs had Sertoli cell tumors in an extratesticular location. One dog and all 5 cats had an extratesticular interstitial cell tumor. Six animals (1 dog, 5 cats) had developed secondary sexual characteristics that reversed after removal of the tumor. All had a palpable mass in the scrotum or at the site of the original prescrotal incision. No animals died of neoplasia-related disease and no metastases were identified. Several possibilities, including the presence of embryological ectopic tissue or the presence of testicular tissue transplanted during castration, are considered as causal.

[Ovarian oxyphilic Sertoli cell tumor: case report and review of the literature]

Ovarian oxyphilic Sertoli cell tumor is a rare neoplasm (only three cases were reported in literature). Sometimes the rarity itself of a lesion raises some problem in the diagnostics, especially if the case is send to several consultants. An unusual case of ovarian neoplasm came to our attention, and we sent some slides of the case to two well known referees of different Departments of Pathology. Pathologist 1 made a diagnosis of endometrioid adenocarcinoma, while Pathologist 2 made the diagnosis of oxyphilic Sertoli cell tumor. He sends the same slides to Pathologist 1, who confirmed his diagnosis. The two different diagnosis set different managements of the lesion for the clinician, but overall they set the pathologist who requested the consultation in a difficult position. In fact, when a pathologist sends to two experienced consultants a case, he really thinks to solve definitely the case itself. Unfortunately, sometimes it does not happen.

High TGFbeta1, estrogen receptor, and aromatase gene expression in a large cell calcifying sertoli cell tumor (LCCSCT): implications for the mechanism of oncogenesis

Large cell calcifying Sertoli cell tumors (LCCSCT) are associated with Carney complex and Peutz-Jeghers syndrome. The mechanisms linking these 2 genetic defects to the genesis of this tumor are obscure. Studies of CYP19 (aromatase) and transforming growth factor (TGF)-beta1 messenger RNA (mRNA) abundance, estrogen receptor (ER), TGFbeta1, and TGFbeta type II receptor (R) immunochemistry were carried out in the testis of a patient with this tumor to gain information on possible mechanisms of cell tumor development. Testicular tissue of a prepubertal patient, collected at gonadectomy, was separated into 2 macroscopically distinct fractions: tumoral nodules (Tu) and extratumoral, normal-looking testicular tissue (ExTu). The patient was a 9.5-year-old boy with a 5-year history of bilateral gynecomastia (Tanner stage 4), no pubic hair, incipient genital development, and bilateral testicular nodules. Multiple pigmented lesions of the skin were present. Bilateral mammectomy and gonadectomy was performed. RNA was extracted from Tu and ExTu for semiquantitative reverse transcriptase-polymerase chain reaction of CYP19 and TGFbeta1. Protein expression of ER, TGFbeta1, and TGFbeta type II R in Tu and ExTu was detected by immunohistochemistry. Cell proliferation was estimated by Ki-67 antigen immunochemistry and apoptosis using a modified TUNEL assay. Mean expression of aromatase and TGFbeta1 mRNAs in Tu was 6- and 2.3-fold higher than in ExTu, respectively (P<0.05). Tumoral cells exhibited ER staining with a predominant extranuclear localization. Positive staining of Sertoli cells in Tu was higher than in ExTu. TGFbeta1 immunostaining of the interstitial cells in Tu was higher than in ExTu. TGFbeta type II R immunostaining was detected in most Sertoli and interstitial cells, but intensity in ExTu was lower than in Tu. No significant difference was detected in the proliferation index, but in Tu, the percentage of Sertoli cells in apoptosis (1.4%) was significantly lower (P<0.01) than in ExTu (14.0%). The following hypothesis is proposed. The congenital gene defects of Carney complex or of Peutz-Jeghers syndrome might trigger a cascade of intracellular events that leads to overexpression of aromatase in Sertoli cells, favoring the development of a LCCSCT. At some point in the evolution of the disease, a mutational event might induce a higher expression of the ER. Also, TGFbeta1 protein expression is increased in neighboring cells. In this environment, TGFbeta1 might switch from tumor suppressor to oncogenic factor and, along with estrogen-ER complexes, might favor tumor progression by inhibiting apoptosis.

Prepubertal gynecomastia in Peutz-Jeghers syndrome: incomplete penetrance in a familial case and management with an aromatase inhibitor

BACKGROUND

Peutz-Jeghers syndrome (PJS) is a rare autosomal-dominant disorder characterized by multiple gastrointestinal hamartomatous polyps, mucocutaneous pigmentation and increased predisposition to various neoplasms. Endocrine manifestations in PJS include gynecomastia due to calcified Sertoli cell testicular tumors usually referred to as large-cell calcifying Sertoli cell tumors (LSCT).

OBJECTIVE

To evaluate the value of endocrine markers and aromatase inhibitor treatment in children with PJS and LSCT.

DESIGN AND SETTING

Familial cases, followed in a tertiary care center.

PATIENTS

Two male siblings aged 7 and 9 years with PJS and LSCT.

INTERVENTION

Third generation aromatase inhibitor (anastrozole) in one of the patients.

MAIN OUTCOME MEASURES

Longitudinal measurements of sex-steroids, gonadotropins, Sertoli cell markers and auxological evaluation.

RESULTS

The two male siblings with PJS had similar bilateral multifocal testicular calcifications and biochemical evidence of Sertoli cell dysfunction manifested by elevated plasma inhibin-alpha levels. Only one sibling had gynecomastia. Estradiol levels were normal in both. During treatment with anastrozole, estradiol levels, growth and skeletal maturation, as well as Sertoli cell markers (inhibin B, inhibin-alpha and anti-Mullerian hormone) decreased.

CONCLUSIONS

Inhibin-alpha may be considered as a marker for LSCT in children with PJS, pointing to a specific defect in inhibin regulation in this condition. Moreover, the decrease in Sertoli cell markers during aromatase inhibitor treatment suggests that increased estrogen production is a primary event regulating downstream production of Sertoli cell peptides. Anastrozole is efficient in controlling the clinical features of the disease and should be proposed as an alternative to bilateral orchidectomy, which is often performed in this condition.

Mitotic activity of Sertoli cells in adult human testis: an immunohistochemical study to characterize Sertoli cells in testicular cords from patients showing testicular dysgenesis syndrome

During puberty, normal somatic Sertoli cells undergo dramatic morphological changes due to the differentiation of immature pre-Sertoli cells in functionally active adult Sertoli cells. Sertoli cell maturation is accompanied with loss of their mitotic activity before onset of spermatogenesis and loss of pre-pubertal and occurrence of adult immunohistochemical Sertoli cell differentiation markers. Testes of infertile adult patients often exhibit numerous histological signs of testicular dysgenesis syndrome (TDS) such as microliths, Sertoli cell only (SCO) tubules, tubules containing carcinoma in situ and immature seminiferous tubules (Sertoli cell nodules). Sertoli cell tumours, however, are very rare neoplasms possibly due to the fact that the mechanism and temporal origin of neoplastic Sertoli cells underlying Sertoli cell tumourigenesis still remain unknown. To clarify the state of Sertoli cell differentiation in both immature seminiferous tubules of adult patients with TDS and Sertoli cell tumour, we compared the expression of the Sertoli cell differentiation markers vimentin, inhibin-alpha, anti-Muellerian-hormone, cytokeratin 18, M2A-antigen, androgen receptor and connexin43 with that of SCO tubules with hyperplasia. In addition, we demonstrated for the first time the existence of proliferating Sertoli cells by Ki67- and PCNA-immunostaining in Sertoli cell nodules of the adult human testis. Our data indicate that mitotically active Sertoli cells in Sertoli cell nodules will be arrested prior to puberty and, contrary to dogma, do not represent foetal or neonatal cells. Since all markers in Sertoli cell nodules revealed a staining pattern identical to that in neoplastic Sertoli cells, but different to that in Sertoli cells of SCO tubules with hyperplasia, it may be speculated that Sertoli cell tumours in adult men may originate from Sertoli cell nodules.

Sertoli cell tumor: a rare case in an elderly patient

Sertoli-Leydig cell tumors constitute < 1% of ovarian tumors, mostly in young women with virilization; however, not all present endocrine manifestations. A 72-year-old female presented with an abdominal mass and no signs of virilization. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy and selective pelvic lymphadenectomy was performed. The pathologic diagnosis was poorly-differentiated sex cord-stromal tumor with Sertoli cells. No adjuvant chemotherapy or radiation was administered. At 12-month follow-up the patient showed no evidence of disease.

Large-Cell Calcifying Sertoli Cell Tumour of the Testis Detected at Screening of a Family with Carney Syndrome

We report the detection of a large-cell calcifying Sertoli cell tumour (LCCSCT) in a 34-year-old male during screening of a family with Carney syndrome. The patient had ignored the testicular swelling for 7 years. He also had a cardiac myxoma. The LCCSCT in this patient had prognostically unfavourable features such as large size (>6 cm) and a high mitotic rate. There is only one previous report of a malignant LCCSCT in a patient with Carney syndrome.

[A case of Sertoli cell tumor]

We report a case of Sertoli cell tumor. A 33-year-old man visited our clinic with a complaint of painless left scrotal swelling on September 29th, 2003. An elastic firm induration larger than a hen's egg in size was palpable on the surface of the left testis. Tumor markers for testicular tumor such as human chorionic gonadotropin-beta, alpha fetoprotein, and lactate dehydrogenase were not elevated. However, ultrasound showed a low echoic mass in the left testis. Therefore, we performed left high orchiectomy under the diagnosis of left testicular tumor. Its histology showed Sertoli cell tumor. Neither recurrence nor metastasis has been detected for about 8 months after the operation.

Very high alpha-fetoprotein in a young man due to concomitant presentation of hepatocellular carcinoma and Sertoli cell testis tumor

Studies reported that there is a close relationship between hepatocellular carcinoma (HCC) and testis carcinoma. Both tumors can be presented as synchronal tumors, or as testicular metastases of HCC or as hepatic metastases of testicular tumor( [7] ). HCC is one of the most common malignancies worldwide and the incidence of HCC increases with age( [8] ). The relationship between hepatitis B incidence and HCC rates is also well recognized. Alpha fetoprotein (AFP) is produced by 70% of HCC. Though a level of AFP >400 ng/mL is diagnostic for HCC, in the presence of active hepatitis B infection, the cut-off level should be considered to be at least 1 000-4 000 ng/mL. Like HCC, germ cell tumors of the testis also release AFP; but it is shown that some of Sertoli cell tumors of testis can also release AFP( [10] ). Herein we have reported about the first case of HCC in the literature which is presented concomitantly with Sertoli-Leydig tumor of testis, leading to extremely high level of AFP in a 21-year-old man.

Sclerosing Sertoli cell tumor of the testis

Sclerosing Sertoli-cell tumor is a rare, sex-cord-stromal tumor of the testis with distinct clinical and pathological features with only 14 such cases reported in contemporary literature. We report such a tumor in a young diabetic and hypertensive male. Serum beta-HCG, alpha-protein and LDH levels were normal. Pathological examination of right radical orchidectomy specimen was consistent with sclerosing sub-type of Sertoli-cell testicular tumor with no invasion. He remains free of disease recurrence at 6 years following surgery.

Cytologic Features of Testicular Tumours in Dog

In this paper, we report on our experience of cytology of fine needle biopsies performed on 92 dogs with testicular tumours during the period from 1998 to 2002. Cytological diagnosis was consistent with seminoma in 20 cases, sertolioma in 16 cases, Leydig cell tumours in 50 cases and mastocytoma in one case. Five cases could not be diagnosed by cytology. Cytological observations were confirmed after surgery by histopathological examination in 87 cases. Cytology provided a sensitivity of 95% for seminoma, 88% for sertolioma and 96% for Leydig cell tumours. The specificity was 100% for all three tumour types. In our experience cytology of fine needle aspirations of testicular tumours is a very reliable technique.

Sertoli cell tumor of the testis in children: reevaluation of a rarely encountered tumor

Testis tumors are uncommon in childhood, and they differ from adult tumors in terms of histology and frequency. Sertoli cell tumors appear in children before 1 year of age. They are more frequently benign, but because of the absence of specific signs of malignancy, treatment consists of radical orchiectomy, sometimes followed by radiotherapy or chemotherapy based on histologic analysis. Malignancy is confirmed by the presence of metastasis or many mitosis and anaplastic cells. Children must be followed for several years to be sure of the absence of relapse or progression. In the authors' hospital, of 13 testis tumors diagnosed since 1996, only 2 were Sertoli cell tumors. It would be helpful to have an algorithm for the management of testis tumors, outlining how to make the diagnosis of malignancy and which treatment and follow-up to pursue.