Sertoli cell nodule

Sertoli Cell Nodule (also known as a Sertoli Cell Adenoma or Pick's Adenoma) is a benign tumor of the Sertoli cells, which are a type of nurse cell located in the seminiferous tubules of the testis. These cells are essential for the process of spermatogenesis, as they support and nourish the developing spermatozoa. Sertoli cell nodules are relatively rare and usually present as a painless testicular mass. They are most often discovered incidentally during an ultrasound examination or as part of the evaluation for infertility or testicular pain.

Etiology and Pathogenesis

The exact cause of Sertoli cell nodules remains unclear. However, they are thought to arise from an overproliferation of Sertoli cells within the seminiferous tubules. This condition can occur sporadically or be associated with certain genetic syndromes such as Peutz-Jeghers syndrome and Carney complex. In some cases, Sertoli cell nodules have been linked to hormonal imbalances, particularly increased levels of follicle-stimulating hormone (FSH).

Clinical Features

Sertoli cell nodules are typically asymptomatic and are often discovered incidentally during an examination for another condition. When symptoms do occur, they may include a palpable mass within the testis, testicular pain or discomfort, and, rarely, signs of gynecomastia due to hormonal secretion by the tumor. Infertility can also be a presenting feature, as the tumor may interfere with normal spermatogenesis.

Diagnosis

The diagnosis of a Sertoli cell nodule is primarily based on imaging studies, with ultrasound being the most commonly used modality. Ultrasound may reveal a well-circumscribed, hypoechoic lesion within the testis. Further characterization of the lesion can be achieved with magnetic resonance imaging (MRI), which provides more detailed information about the tumor's size, location, and relation to surrounding structures. Definitive diagnosis, however, requires histological examination of the tissue, typically obtained through a surgical biopsy or removal of the tumor.

Treatment

The treatment for Sertoli cell nodules depends on the size of the tumor, the presence of symptoms, and whether malignancy is suspected. Small, asymptomatic nodules may simply be monitored over time with periodic ultrasound examinations. Larger or symptomatic nodules, as well as those with suspicious features on imaging, may require surgical removal. The surgical approach can vary from testis-sparing surgery, where only the tumor is removed, to radical orchiectomy, where the entire affected testis is excised. The choice of surgery depends on the clinical scenario and the patient's preference, especially concerning fertility considerations.

Prognosis

The prognosis for individuals with Sertoli cell nodules is generally excellent, as these tumors are benign and do not metastasize. Surgical removal is curative in most cases, and the risk of recurrence is low. However, regular follow-up is recommended to monitor for the development of new nodules or changes in existing ones.

See Also

• Testicular cancer
• Spermatogenesis
• Ultrasound
• MRI