title: A case report of Sertoli cell tumor in a patient with testicular feminization: many dilemmas for the pathologist.
abstract: OBJECTIVE
  The aim of this case report is to present the pathological, clinical, and ethic problems due to the diagnosis of an adnexal mass in a female patient with an undetected androgen insensitivity syndrome.
  
  
  METHODS
  We employed both commonly used pathologic techniques, such as hematoxylin-eosin staining and immunohystochemistry, both fluorescence in situ hybridization on paraffin-embedded tissue sections using probes for chromosomes X and Y.
  
  
  RESULTS
  At pathologic evaluation, a diagnosis of Sertoli cell tumor was made. Fluorescence in situ hybridization showed an XY karyotype of tumor cells. The final diagnosis was bilateral Sertoli cell adenoma in a patient with testicular feminization syndrome.
  
  
  CONCLUSIONS
  Androgen insensitivity syndrome is caused by insensitivity of end organs to androgen caused by a non-functioning receptor. The diagnosis of testicular feminization has been made as late as the ninth decade. In this case, two kinds of problem derived from the pathologist point of view: first, the demonstration of chromosomal sex to confirm the diagnosis, and second, the transfer of diagnosis to the patient and to the clinicians.
authors.affiliation: Institue of Pathology, Faculty of Medicine, University of Udine, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Spizzo
authors.forename: Donatella
authors.initials: D
authors.lastname: Intersimone
authors.forename: Daria
authors.initials: D
authors.lastname: Artico
authors.forename: Lorenza
authors.initials: L
authors.lastname: Driul
authors.forename: Carla
authors.initials: C
authors.lastname: Di Loreto
authors.forename: Carlo Alberto
authors.initials: CA
authors.lastname: Beltrami
mesh_terms: D000368:Aged; D013734:Androgen-Insensitivity Syndrome / Q000473:pathology* / Q000601:surgery; D041321:Chromosomes, Human, X; D041322:Chromosomes, Human, Y; D005260:Female; D005262:Feminization; D006801:Humans; D017404:In Situ Hybridization, Fluorescence; D008297:Male; D009852:Omentum / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery; D010052:Ovariectomy; D012707:Sertoli Cell Tumor / Q000473:pathology* / Q000601:surgery; D016896:Treatment Outcome