睪丸支持細胞瘤 個案報告及文獻回顧

洪健哲 唐靖 羅華安

國泰綜合醫院 外科部 泌尿科

Sertoli Cell Tumor of Testis: Case Report and Review of the Literature

Chien-Che Hung, Chin Tang, Wah-On Lo

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract

  Sertoli cell tumor is a rare diagnosis of testis tumor and may be easily misdiagnosed. We presented a case of a 27-year-old male without any history mentioned before. Initially, he came to our out-patient department for right scrotal pain radiating to right lower quadrant of abdominal region. There was no obvious finding through KUB. However, immediate scrotal ultrasound demonstrated right testis with heterogeneous lesion about 3.2 * 2.6 cm in size and irregular contour which also emerged with increasing blood flow. Right testicular epididymal-orchitis was initially impressed and antibiotics was further prescribed for infection control. However, fever up to 38.7 celsius degree was noted and he was brought to our emergency department for further hospitalization.

After he discharged from our hospital, he was regularly followed up his clinical condition and testicular ultrasound. Right scrotal pain was improved but still presented with a heterogeneous tumor-like lesion of right testis. For fear of any risk of malignancy, tumor markers were checked and revealed AFP = 4.6 ng/mL, β-hCG <0.1 mIU/mL, LDH = 153 which were all within normal range. Nonetheless, due to limited symptoms and the COVID-19 pandemic, he lost followed for almost a year. Suddenly, he came back to our OPD presented with recurrent right scrotal tenderness, poor appetite, nausea, and body weight loss over 10 kilograms in 2 months. Testis echo revealed enlarged right testis tumor with heterogeneous texture. CT was further prescribed and illustrated a 7.8 cm right testis tumor. Operation was suggested for recurrent symptoms and tissue proving. Under the impression of right testis tumor, right radical orchiectomy was performed, and a 8.7 * 6 cm tumor was removed smoothly. Pathological report demonstrated a malignant sertoli cell tumor with nested and tubular pattern. The patient was discharged 3 days after operation without specific discomfort nor clinical sequel.

Sertoli cell tumors (SCTs) constitute less than 1% of testis neoplasms, and approximately 10% are malignant. The literature provides only weak evidence concerning their clinical course and management. The median age at diagnosis is 45 years, but rare cases in boys have been reported. Sertoli cells with varying amounts of stroma organized into tubules. These tumors may be misinterpreted as seminoma leading to errors in the selection of treatment. Unfortunately, although most are benign, the ultrasound appearance overlaps with malignancy, and the majority are diagnosed after orchiectomy. Therefore, we present this case to share our experience of diagnosis and management of this obfuscated case.