Macroscopic sertoli cell nodule: a study of 6 cases that presented as testicular masses

Sertoli cell nodules are almost always incidental microscopic lesions found in both cryptorchid and normally descended testes. Sertoli cell nodules, when present as masses or ultrasonographic lesions, may create diagnostic confusion. Herein, we report 6 cases of macroscopic Sertoli cell nodules that were received in consultation. The referral diagnoses included Sertoli cell tumor (2 cases), sex cord tumor with annular tubules (1 case), and gonadoblastoma (1 case). The patients were 19 to 36 years old: 3 patients presented with palpable testicular masses and 3 with lesions that were worrisome for neoplasms in ultrasonographic examinations conducted for pain (2 cases) or infertility (1 case). All were phenotypically normal male patients who lacked endocrine symptoms. The Sertoli cell nodules ranged from 6 to 10 mm in diameter and on microscopic examination consisted of circumscribed proliferations of immature Sertoli cells, globules and trabeculae of basement membrane, and spermatogonia in varying proportions. In 2 cases the lesion was distinctly intratubular, consisting of closely packed tubules containing various components; in the other cases there was confluent growth of the tubules. Immunostains for α-inhibin highlighted the Sertoli cells (5 of 5 cases), with the germ cells appearing in negative relief. An antibody for testis-specific protein, Y-encoded (TSPY), stained the spermatogonia (2 of 2 cases), whereas OCT 3/4 was negative in all the cases (5 of 5 cases). We conclude that Sertoli cell nodules may present clinically as mass lesions, and that it is important to distinguish them from true neoplasms to avoid unnecessary procedures.