Sertoli cell tumors
Sertoli cell tumors are rare, typically benign tumors originating in Sertoli cells within the testes, which play a crucial role in nourishing sperm-producing germ cells. While they account for less than 1% of all testicular tumors, Sertoli cell tumors are most commonly diagnosed in individuals aged 30 to 40. Risk factors include genetic abnormalities and a family history of testicular cancer, and they are often associated with Peutz-Jeghers syndrome, a condition characterized by the development of noncancerous growths. Symptoms are usually minimal, often presenting as a painless lump in the testicles, although hormonal imbalances may lead to conditions such as gynecomastia or premature puberty in boys.
Diagnosis typically involves physical examination, ultrasound imaging, and possibly CT scans if cancer is suspected. Surgical removal of the tumor, or orchiectomy, is the standard treatment, with testis-sparing techniques showing promising outcomes for younger patients. While benign tumors have a good prognosis post-surgery, malignant cases may require additional treatments such as chemotherapy and radiation. There is no known way to prevent Sertoli cell tumors, but monitoring after surgical intervention is essential to check for potential recurrence.
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Subject Terms
Sertoli cell tumors
ALSO KNOWN AS: Androblastomas, large-cell calcifying Sertoli cell tumors, sclerosing Sertoli cell tumors
RELATED CONDITIONS: Leydig cell tumors, Sertoli-Leydig cell tumors of the ovaries
DEFINITION: Sertoli cell tumors are rare, typically benign stromal tumors that form in the Sertoli cells of the testes, which nourish the sperm-producing germ cells.
Risk factors: Sertoli cell tumors are believed to arise from genetic abnormalities. Having a family history of testicular cancer may increase the risk. Sertoli cell tumors are often associated with Peutz-Jeghers syndrome (PJS), a rare inherited condition that causes many noncancerous growths to form in the stomach and intestines.
Etiology and the disease process: Sertoli cell tumors are thought to arise from chromosomal abnormalities. Benign tumors do not typically progress, but malignant tumors can spread to the lymph nodes, bones, liver, or lungs.
Incidence: Sertoli cell tumors account for less than 1 percent of testicular tumors, with typical cases diagnosed between 30 and 40 years of age, though they may occur at any age. These tumors are usually benign, but 10 to 25 percent of cases may be malignant.
Symptoms: Sertoli cell tumors are often painless and produce no symptoms aside from a lump in the testicles. In rare cases, these types of tumors can release male or female hormones. Release of the female hormone estrogen can cause the patient to develop symptoms such as breast tenderness and enlargement (gynecomastia) or loss of sexual desire. Release of the male hormone testosterone can cause boys to enter puberty prematurely.
Screening and diagnosis: The doctor will feel the testicles and abdomen to identify any lumps or masses. An ultrasound can be used to visualize the tumor. If the tumor is cancerous, the patient may have a computed tomography (CT) scan of the abdomen and pelvis and a chest X-ray to determine disease progression. Small tumors are often misdiagnosed as germ cell tumors.
Treatment and therapy: Surgery to remove the testicles (orchiectomy) is the standard treatment for Sertoli cell tumors. In younger patients, the surgeon will attempt to spare the testes from significant damage. Advances in testis-sparing surgery have resulted in increasing low reoccurrence rates with no need for adjuvant therapies. Further, these surgical techniques have been effective in treating metastatic disease, allowing the cancer to go into remission. However, in cases of metastases, it did not allow for long-term remission. Cancerous tumors can be treated with chemotherapy, radiation, and surgery to remove the involved lymph nodes.
Prognosis, prevention, and outcomes: Sertoli cell tumors cannot be prevented. However, the prognosis is good for children with nonmalignant tumors who have surgery to remove them. Following surgery, patients may need to be monitored for several years to check for recurrence.
Bibliography
Grogg, Josias, et al. "Sertoli Cell Tumors of the Testes: Systematic Literature Review and Meta‐Analysis of Outcomes in 435 Patients." The Oncologist, vol. 25, no. 7, 2020, pp. 585-590, doi.org/10.1634/theoncologist.2019-0692. Accessed 24 June 2024.
Henley, John, D., et al. “Malignant Sertoli Cell Tumors of the Testis: A Study of 13 Examples of a Neoplasm Frequently Misinterpreted as Seminoma.” The American Journal of Surgical Pathology, vol. 26.5, 2002, pp. 541-50, doi:10.1097/00000478-200205000-00001.
Kane, Kenny. “A Breakdown of the Different Stages of Testicular Cancer and What Each Stage Means.” Testicularcancer.org, 19 June 2024, testicularcancer.org/testicular-cancer-101/a-breakdown-of-the-different-stages-of-testicular-cancer-and-what-each-stage-means. Accessed 24 June 2024.
“Testicular Cancer - Testicular Tumor.” American Cancer Society, www.cancer.org/cancer/types/testicular-cancer.html. Accessed 24 June 2024.
“Types of Testicular Cancer.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/conditions-and-diseases/testicular-cancer/types-of-testicular-cancer. Accessed 24 June 2024.