Feminizing and non-feminizing Sertoli cell tumors

Sertoli cell tumors (tumor of specialized gonadal tissue, androblastoma) are relatively uncommon and appear to be derived from the embryonic mesenchyma, the Sertoli and interstitial (Leydig) cells being derived from a common anlage. Interstitial cell tumor and Sertoli cell tumors may be feminizing. The former often is virilizing and the latter, as in our patient, may manifest some virilizing features. An encompassing hypothesis may be that the interstitial cell and Sertoli cell are derived from the same precursor cell, the former differentiating into a cell capable of steroid elaboration particularly of androgen and, to a lesser extent, as a consequence of its XY complement of estrogen. The Sertoli cell differentiates as a nutrient cell for sustaining spermatogenesis and loses, in large measure, its capacity for steroidogenesis. Under unusual circumstances the Sertoli cell tumor may be capable of increased steroidogenesis in a manner similar to the derepression one sees in the polypeptide secreting tumors of the lung. The embryologic derivation of the Sertoli cell tumor is seen in the pleomorphic cellular pattern seen in these tumors. It might be advisable to use the term Sertoli cell-interstitial cell tumor with subdivision into the 2 types to emphasize the common derivation, the differentiation into steroidogenic and sustentacular types with the ability of the Sertoli cell tumor, especially if malignant, to exhibit the steroidogenic potential of the embryonic mesenchyma.