sertoli leydig tumor


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  • Clinical

    • mean age 25
    • younger if DICER1 mutation or retiform pattern
    • virilization+/-
    • AFP+/- if heterologous elements

  • Histology

    • well diff
      • sertoli: most tubules, no atypia, no mitosis
      • leydig: present
      • stroma: fibrous
      • lack heterologous or retiform elements
    • mod diff
      • sertoli: lobules, less tubules, blue, mild atypia, mitosis 5 / 10hpf
      • leydig: less
      • stroma: edematous
      • heterologous elements +/-
      • retiform +/-
    • poor diff
      • sertoli: least tubules
      • leydig: least
      • stroma: major component, sarcomatoid primitive gonadal stroma, mitosis up to 20 / 10hpf
      • heterologous elements +/-
      • retiform +/-
    • retiform
      • architecture: anastomosing, slit, papillary, multicystic, sieve-like
      • lining: flat, cuboidal, columnar
    • heterologous
      • epithelial or mesenchymal
      • most common mucinous: +/- borderline or carcinoma
      • less common mesenchymal: cartilage, skeletal muscle
      • hepatocytes vs Leydig: bile, acini, stains
      • up to 20% of cases
      • negative in well diff cases
      • AFP+/-

  • Stains

    • inhibin+
    • FOXL2+/-
    		•