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Unclassified sex cord stromal tumor

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  • sayhey
    replied
    Below is my pathology report. I've removed the clinical history since I detailed it above, and edited out the name of what was likely the supervising doctor for their privacy.

    FINAL PATHOLOGIC DIAGNOSIS


    Left testicle and spermatic cord, radical orchiectomy:
    - Testis: Unclassified sex cord stromal tumor with spindle cells, 1.7
    cm; see comment.
    - Spermatic cord: No significant pathologic abnormality.


    COMMENT:
    Sections from the testis show a well circumscribed mass that consists
    predominantly of a cellular spindle cell proliferation growing in a
    somewhat fascicular pattern. The cells contain moderate to focally
    abundant eosinophilic cytoplasm and ovoid to spindle nuclei that are
    hyperchromatic and contain prominent eosinophilic nucleoli. Brisk
    mitotic activity is present, up to 10 mitoses per 10 high power fields.
    Subtle intermixed tubular structures and Sertoliform areas are
    identified. There are scattered variably prominent foci of intermixed
    round to ovoid cells with abundant clear cytoplasm and round nuclei with
    inclusions. Also noted at the periphery are occasional seminiferous
    tubules, some with a mix of the clear round cells and the dark spindle
    cells. The surrounding testicular parenchyma shows evidence of atrophy
    in the form of tubular hyalinization and Leydig cell hyperplasia. No
    definitive germ cell neoplasia in situ is identified.
    Based on the morphology, the differential diagnosis could include a
    mixed germ cell and sex cord stromal tumor, an unusual pure germ cell
    tumor and a pure sex cord stromal tumor, amongst others.
    Immunohistochemical studies were necessary to evaluate this case and
    establish the correct diagnosis. The following immunohistochemical
    stains were performed and evaluated on A2:

    - OCT4: Negative.
    - SALL4: Negative.
    - Keratin: Patchy positive.
    - Chromogranin: Negative.
    - Synaptophysin: Negative.
    - Inhibin: Patchy positive.
    - Calretinin: Focal positive in spindle cells, positive in round cells
    with clear cytoplasm.
    - SF-1: Patchy positive.
    - FOXL2: Positive.
    - SMA: Positive.
    - Desmin: Patchy positive.
    - S-100: Patchy positive.
    - Melan-A: Negative.

    In addition a reticulin stain shows staining around nests of cells (in a
    background of staining around individual cells).

    Overall the morphology and immunoprofile is most supportive of a sex
    cord stromal tumor. We considered various possibilities including a
    Sertoli cell tumor, Sertoli-Leydig cell tumor, granulosa cell tumor and
    some unusual tumors such as myoid gonadal stromal tumor and spindle
    Leydig cell tumor but ultimately feel that this unusual tumor is best
    categorized as a sex cord stromal tumor, unclassified, with spindle
    cells.
    The prognosis of these tumors is difficult to predict and while the
    small size and lack of necrosis or lymphovascular invasion are favorable
    features, the elevated mitotic activity may portend a risk for
    recurrence. Therefore clinical follow up is recommended.
    Dr. [name removed] reviewed this case and agrees with the diagnosis.

    Laterality: Left.
    Focality: Unifocal.
    Tumor size: 1.7 x 1.4 cm.
    Tumor histologic type: Sex cord stromal tumor, unclassified, with
    spindle cells.
    Tumor extension: Tumor limited to testis.
    Spermatic cord margin: Uninvolved by tumor.
    Other margin(s): Negative.
    Lymphovascular Invasion: Not identified.
    Regional lymph nodes: No lymph nodes submitted.
    Additional pathologic findings: Atrophy.

    Pathologic stage classification (pTNM, AJCC 8th Edition): pT1NX.
    Pre-orchiectomy serum tumor markers: AFP, HCG and LDH within normal
    limits.
    Post-orchiectomy serum tumor markers: Not known.
    Serum tumor marker stage (S): Not known.
    AJCC prognostic stage group: Not known.

    Specimen(s) Received

    A:1) Left Testicle - perm.

    Gross Description

    The case is received fresh in one part and is labeled with the patient's
    name, medical record number, and additionally labeled "left testicle"
    and consists of one testicle and attached spermatic cord (43.2 g,
    spermatic cord: 9 x 2 x 1 cm, testicle: 4.1 x 2.9 x 2.7 cm, epididymis
    6.2 x 1.8 x 0.4 cm, and appendage 1.2 x 1 x 0.7 cm). The tunica
    vaginalis is intact. There is a pale yellow, firm mass in the parenchyma
    of the testicle (1.7 x 1.4 x 1.1 cm) that abuts the tunica albuginea but
    does not invade, and is 0.1 cm from the tunical vaginalis. The remainder
    of the parenchyma is pink colored and soft. The epididymis is soft and
    grey, the tunica albuginea is pale grey, smooth, with no masses or
    adhesions. The tunica vaginalis is smooth and uninterrupted.

    Leave a comment:


  • sayhey
    replied
    I've got a paper copy of my pathology report (it's five pages long) and I'll post it once I get it in digital form in my online patient portal.

    Elevated mitotic activity is my only risk factor (the cut off is greater than 3 or 5 depending on the paper I've read, and my tumor had up to 10 mitoses per 10 high power fields).

    Leave a comment:


  • Newme2017
    replied
    Hi Sayhey,

    Like you,I had a Stromal Tumor, (Sertoli) and am all too familiar with the 10% to 20% malignancy chance. I have been searching for papers myself for the last 18 months or so, so if I come across any,I would be more than happy to send them your way. Also I am hoping to follow Dave's suggestion, hopefully I will post my pathology info in the next day or two.

    Best,
    ​Mark

    Leave a comment:


  • Davepet
    replied
    Afraid I know absolutely nothing about sex cord stromal tumors other than what you've said. I can't recall another case here, so sorry if no one is jumping in with tons of information. However, there s no doubt in my mind that whatever information you provide may well help the next person with a similar Dx, so please, keep us posted as you find out more.

    Dave

    Leave a comment:

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