LARGE-CELL CALCIFYING SERTOLI-CELL TUMOR OF THE TESTIS - CONTRASTING FEATURES OF 6 MALIGNANT AND 6 BENIGN-TUMORS AND A REVIEW OF THE LITERATURE

We report six malignant and six benign large cell calcifying Sertoli c ell tumors of the testis and compare the features of malignant and ben ign cases based on these cases and those in the literature. All the tu mors in this report consisted of sheets, nests, solid tubules, and cor ds of eosinophilic cells, with focal calcifications, as well as a subs tantial neutrophilic infiltrate in 11 of them. Analysis of our cases a nd those in the literature showed that the malignant tumors were unila teral and solitary and occurred at a mean age of 39 years (range 28-51 years), whereas the benign neoplasms were bilateral and multifocal in 28% of cases and occurred at a mean age of 17 years (range 2-38 years ). Only one malignant tumor occurred in a patient with evidence of a g enetic syndrome (Carney syndrome), whereas 36% of benign tumors had va rious genetic syndromes or endocrine abnormalities. Most of the tumors in the latter cases were bilateral and multifocal. There were strong associations of malignant behavior with size >4 cm, extratesticular gr owth, gross or microscopic necrosis, high-grade cytologic atypia, vasc ular space invasion, and mitotic rate greater than three mitoses per 1 0 high-power fields. All malignant cases exhibited at least two of the se features, whereas all benign cases lacked any of them. The presence of any one of these features in a solitary large cell calcifying Sert oli cell tumor, especially in a patient >25 years of age, should be vi ewed as suspicious for malignant behavior, whereas the presence of two or more of these features indicates a strong probability of a maligna nt course. ''Low'' percentages (less than or equal to 35%) of tumor ce lls staining for proliferating cell nuclear antigen (PCNA) also may co rrelate with benign behavior, but some benign tumors have high PCNA va lues. Ki-67 values (MIB-1 antibody) did not correlate with biologic be havior, nor did immunostains for p53 protein.