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Crouching tiger, hidden dragon
  1. Daniel Hopkins,
  2. Murali Varma
  1. Department of Cellular Pathology, University Hospital of Wales, Cardiff, UK
  1. Correspondence to Dr Murali Varma, Department of Histopathology, University Hospital of Wales, Heath Park, Cardiff CF14 4XN, UK; varmam{at}

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Clinical question

A 34-year-old man presented with a history of bilaterally undescended testes since birth. A bilateral orchidectomy was performed. Macroscopic examination of the specimen demonstrated multiple pale nodules within both testes, the largest of which measured 3 mm in diameter.

Review the high-quality, interactive digital Aperio slide at and consider your diagnosis.

What is your diagnosis?

  1. Germ cell neoplasia in situ (GCNIS)

  2. Leydig cell hyperplasia

  3. Seminoma

  4. Sertoli cell nodule

  5. Sertoli cell tumour

The correct answer is after the discussion. 


The submitted section demonstrates features of cryptorchidism, with marked hyalinisation of the tubular basement membrane, germ cell atrophy and Leydig cell hyperplasia (figure 1A,B). Most of the seminiferous tubules are lined only by Sertoli cells. However, there are also multiple small nodular aggregates of Sertoli cells that correspond to the macroscopically described abnormality (figure 1A,C,D). These have been occasionally referred to by the misnomer ‘Pick’s Adenomas’ but have been shown to be polyclonal and best referred to as Sertoli cell nodules.

Figure 1

The testis (A) shows germ cell atrophy with basement membrane thickening and Leydig cell hyperplasia in keeping with cryptorchidism (B) as well as Sertoli cell nodules (C,D). (A–D: H&E).

On low-power examination some of the atrophic tubules contain peripherally located cells with clear cytoplasm that on closer examination show cytological atypia with prominent nucleoli (figure 2). This represents in situ malignancy that has been referred to as ‘carcinoma in situ’ or ‘intratubular germ cell neoplasia’. However, these …

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  • Handling editor Iskander Chaudhry.

  • Contributors The case was identified by MV. Both authors contributed equally to writing the manuscript.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Provenance and peer review Commissioned; internally peer reviewed.