Differential Diagnosis of Sertoli Cell Nodules

Sertoli cell nodules, also known as Pick’s adenoma, tubular adenoma, or hypoplastic zones, consist of a conglomerate of hypoplastic seminiferous tubules. They represent an anomaly in the growth and development of some seminiferous tubules by the inability to complete maturation of the Sertoli cells that constitute them. Sertoli cells produce abundant PAS-positive material with characteristics of the basement membrane, which protrudes into the tubules simulating Call-Exner bodies and determining a peculiar arrangement of the Sertoli cells around them. Their variable size, their varied morphology and the different degree of maturation of the Sertoli cells, and the possibility of containing germ cells usually complicate what should be an easy diagnosis. Differential diagnoses arise with the following entities: intratubular large cell hyalinizing Sertoli cell neoplasia, gonadoblastoma, sex cord tumor with annular tubules, Sertoli cell tumor “not otherwise specified,” and others like gonadoblastoid testicular dysplasia, Sertoli-Leydig hamartoma, and Sertoli cell adenoma. Differential diagnosis with Sertoli cell tumors is especially important as these often are associated with syndromes such as Peutz-Jeghers or the gonadoblastoma that most often develops in a patient with a disorder of sexual development.