Asymptomatic Sertoli cell tumour diagnosed during azoospermia work-up

Abstract

within the normal limits. Based on genetic examination, the karyotype was normal (46,XY), and no microdeletion was observed on the Y chromosome. The patient, who had a presumed diagnosis of a testicular tumour, underwent radical orchiectomy. Tissues from healthy parts of the testicle were sent to the andrology laboratory, and the observed spermatozoa underwent cryopreservation. Histopathological examinationrevealeda nodular, grey-white lesionof8 mm indiameter that was limited to the testicle and consistent with a classical Sertoli cell tumour without mitosis. Inhibin, vimentin and cytokeratin staining were positive in an immunohistochemical examination. No pregnancy was achieved with intracytoplasmic sperm injection applications using cryotesticular sperm extraction (TESE) in 2006 and 2007. In 2010, a twin pregnancy and twin live birth were achieved with intracytoplasmic sperm injection application using fresh TESE. The patient was tumour free in the 5-year follow-up period. Sertoli cell tumours, in the category of sex cord stromal tumours, account for only 1% of all testicular tumours. In total, 170 cases have beenreportedintheliterature. 4 Thefirstsignisusuallyapainlessmass, and the serum levels of alpha-fetoprotein, b-human chorionic gonadotropin and lactate dehydrogenase are within the normal limits. As for all testicular tumours, the risk of developing a Sertoli cell tumour increases in patients with undescended testicles and those who have beenoperatedonforthiscondition. 5 Sertolicelltumoursareobserved as nodular masses that are easily distinguished from testicular tissue during ultrasound examination. Although organ-sparing treatment is recommended in the form of partial orchiectomy, a significant proportion of these patients undergo radical orchiectomy. Immunohistochemical investigations facilitate the approach to the diagnosis. Malignant transformation occurs in approximately 10% of Sertoli cell tumours. Less than 50 cases have been reported in the literature. The malignancy criteria are as follows: a size of more than 5 cm, pleomorphicnucleiwithnucleoli, threeormoremitosesper10magnification fields and vascular spread. 1 Metastasis has been defined in malignant cases. Only 7% of all cases demonstrate metastasis during follow-up. Metastatic disease does not respond well to radio-chemotherapy, and survival is poor. 6 Sertoli cell tumours may be associated with androgenic deficiency, Peutz–Jeghers syndrome and Carney’s syndrome. 6 None of these