Subtitle: Sertoli cell tumours of the testis (WHO 2022): Sertoli cell tumour NOS and CTNNB1, large cell calcifying Sertoli cell tumour (PRKAR1A, Carney complex), sclerosing pattern, Sertoli cell nodules, IHC panel, malignancy criteria, mimics, virtual slides and 8 MCQs.
Author: PathologyMCQ Editorial Board
Category: Urological Pathology
Last Updated: October 2026
Read Time: 6 minutes
At-a-Glance
- Sertoli cell tumour NOS: tubules, cords and sheets in a fibrous or hyalinised stroma; CTNNB1 mutation with nuclear beta-catenin in most; about 10% malignant.
- Large cell calcifying SCT: young patients, large eosinophilic cells, laminated calcification, S100+; 40% syndromic (Carney complex, Peutz–Jeghers).
- Sertoli cell nodule: non-neoplastic, incidental, in cryptorchid and Klinefelter testes.
- Sex cord markers (SF1, SOX9, WT1, inhibin, calretinin) positive; germ cell markers negative.
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Sertoli cell tumours are rare sex cord-stromal tumours of the testis. WHO 2022 recognises Sertoli cell tumour NOS (which includes the sclerosing pattern) and large cell calcifying Sertoli cell tumour. The non-neoplastic Sertoli cell nodule is a common mimic that must not be called a tumour.
Sertoli Cell Tumour NOS
- Age: adults, mean about 45 years; usually a painless mass, rarely hormonal symptoms.
- Histology: well-formed tubules, cords and solid nests of cells with pale to eosinophilic or lipid-rich cytoplasm, in a fibrous, hyalinised or oedematous stroma. The sclerosing pattern (formerly sclerosing Sertoli cell tumour) shows small tubules and cords in dense hyalinised stroma and behaves indolently.
- Molecular: CTNNB1 exon 3 mutation in 60–70%, with nuclear beta-catenin on IHC.
- Behaviour: about 10% metastasise, usually to retroperitoneal nodes.
Large Cell Calcifying Sertoli Cell Tumour
- Age: usually under 20; 40% syndromic (Carney complex with PRKAR1A mutation, Peutz–Jeghers syndrome), then often bilateral and multifocal.
- Histology: large polygonal cells with abundant eosinophilic to amphophilic cytoplasm in cords, trabeculae and nests; myxoid to sclerotic stroma; laminated calcification; a neutrophil-rich infiltrate.
- IHC: strong diffuse S100, calretinin and inhibin; androgen receptor negative in tumour cells.
- Behaviour: usually benign; malignant cases are sporadic, unilateral, in older patients, with size >4 cm, atypia, necrosis, vascular invasion and mitoses >3/10 HPF.
Sertoli Cell Nodule (Not a Tumour)
- Incidental, usually microscopic aggregates of hypoplastic tubules lined by immature Sertoli cells with thick basement membranes and often laminated calcospherites, in cryptorchid, infertile or Klinefelter testes.
- Tubules may contain scattered germ cells; the nodule lacks a mass, atypia and mitoses.
- Report as “Sertoli cell nodule” to avoid an unnecessary diagnosis of tumour.
Criteria for Malignancy in Sertoli Cell Tumour NOS
| Feature | Threshold |
|---|---|
| Size | >5 cm |
| Necrosis | Present |
| Vascular invasion | Present |
| Nuclear atypia | Moderate to severe |
| Mitoses | >5 per 10 HPF |
| Growth | Infiltrative margins |
Metastasis is the only certain proof of malignancy; the tumour may show only focal tubular differentiation, with gain of cytokeratin and neuroendocrine markers and loss of androgen receptor.
IHC and Mimics
| Tumour | Key histology | IHC |
|---|---|---|
| Sertoli cell tumour NOS | Tubules and cords, hyalinised stroma | SF1, SOX9, WT1, calretinin, inhibin (variable), nuclear beta-catenin; OCT4−, SALL4− |
| Large cell calcifying SCT | Large eosinophilic cells, laminated calcification, neutrophils | S100 strong, inhibin, calretinin; AR− |
| Leydig cell tumour | Polygonal eosinophilic cells, lipofuscin, Reinke crystals | Inhibin, calretinin, Melan-A; beta-catenin membranous |
| Seminoma (tubular pattern) | Clear cells, fibrous septa, lymphocytes | OCT4, SALL4, CD117, PLAP; sex cord markers negative |
| Adenomatoid tumour | Vacuolated cells in tubules and cords, paratesticular | Calretinin, WT1, D2-40, cytokeratin; inhibin− |
| Adult granulosa cell tumour | Microfollicles, Call–Exner bodies, grooved nuclei | Inhibin, calretinin, FOXL2 mutation |
Virtual Slides
Normal Sertoli cells within seminiferous tubules, and an adenomatoid tumour, the commonest paratesticular mimic of a tubular sex cord tumour.
What to look for
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Test Yourself: 8 MCQs
Sertoli cell tumours: 8 MCQs
Subtypes, nodules, IHC, molecular and malignancy criteria, with instant explanations.
More practice: the question banks →
Exam Pearls
- SCT NOS: CTNNB1, nuclear beta-catenin; 10% malignant.
- LCCSCT: young, calcified, S100+, Carney/PJS.
- Sertoli cell nodule = cryptorchid testis, not a tumour.
- Reinke crystals = Leydig. OCT4 = germ cell.
- Malignancy: >5 cm, necrosis, LVI, atypia, >5 mitoses.
For tips, pitfalls, notes, reporting templates and worksheets, join the approach-based course in histopathology and cytology →, and see the Histopathology Notes, volumes 1 and 2 →
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References
- WHO Classification of Tumours Editorial Board. Urinary and Male Genital Tumours. 5th ed. IARC; 2022.
- Young RH, Koelliker DD, Scully RE. Sertoli cell tumors of the testis, not otherwise specified: a clinicopathologic analysis of 60 cases. Am J Surg Pathol. 1998;22:709–21.
- Perrone F, et al. Frequent mutation and nuclear localization of beta-catenin in Sertoli cell tumors of the testis. Am J Surg Pathol. 2014;38:66–71.
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