Testicular sex cord-stromal tumours (TSCSTs) are rare neoplasms that arise from (or show differentiation to) elements derived from the sex cords or intertubular stroma. The current classification (World Health Organization, 2022) is based almost entirely on morphology, with many tumour types such as granulosa cell tumours being defined based on their resemblance to ovarian counterparts. Recent studies have uncovered new clinicopathological, molecular and biological nuances within this group of tumours, underscoring differences with ovarian homologues.
Considering the new data, a group of genitourinary pathology experts (Testicular Sex Cord-Stromal Tumour [TESST] group) has proposed a revised 'TESST classification' that incorporates the best available evidence. This classification is structured and hierarchical, composed of the following tiers: (1) group, (2) category, (3) entity and (4) histological pattern. 'Group' refers to the histological compartment a specific tumour belongs to (sex cords, stroma or both), whereas 'category' is defined by the phenotype of the tumour, taking non-neoplastic elements of the ovary and testis as a reference. The third tier, 'entity', refers to neoplasms with shared clinicopathological and/or molecular features that justify classifying them as distinct types. Lastly, 'histological patterns' are recurrent morphological variations within entities that are not linked to distinct clinicopathological or molecular features.
We propose a classification that will provide a framework to improve current clinical management and guide future research in the field.
Histopathology. 2026 Jul 08 [Epub ahead of print]
Andres M Acosta, Felix Bremmer, John C Cheville, Maurizio Colecchia, Eva Comperat, Kristine Cornejo, Dilek E Baydar, Anthony J Gill, Maria Del Pilar Gonzalez-Peramato, Sounak Gupta, Michelle S Hirsch, Muhammad T Idrees, Chia-Sui Kao, Fiona MacLean, Andres Matoso, Rohit Mehra, Santosh Menon, Kvetoslava Michalova, Sambit K Mohanty, Miguel Reyes-Mugica, Maria Rosaria Raspollini, Ankur R Sangoi, Lynette M Sholl, Stephanie Siegmund, Satish K Tickoo, Toyonori Tsuzuki, Thomas M Ulbright, Sean R Williamson, Asli Yilmaz, Daniel M Berney
Department of Pathology, Indiana University, Indianapolis, IN, USA., Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany., Department of Pathology, Mayo Clinic, Rochester, MN, USA., Department of Pathology, Universita Vita Salute San Raffaele, Milan, Italy., Department of Pathology, Medical University Vienna, Vienna, Austria., Department of Pathology, Koc University School of Medicine, Istanbul, Turkey., Department of Pathology, Sydney Medical School, University of Sydney, Sydney, NSW, Australia., Department of Pathology, University Hospital La Paz, Universidad Autónoma de Madrid, Madrid, Spain., Department of Pathology, MassGeneralBrigham/Harvard Medical School, Boston, MA, USA., Department of Pathology and Laboratory Medicine, Diagnostics Institute, Cleveland Clinic, Cleveland, OH, USA., Department of Pathology, Douglass Hanly Moir Pathology, Sonic Healthcare, Sydney, NSW, Australia., Department of Pathology, Johns Hopkins University, Baltimore, MD, USA., Department of Pathology, University of Michigan, Ann Arbor, MI, USA., Department of Pathology, Tata Memorial Centre, Mumbai, India., Department of Pathology, Charles University, Faculty of Medicine in Plzen, Biopticka Laborator, Ltd, Plzen, Czech Republic., Department of Pathology, CORE Diagnostics, Gurgaon, Haryana, India., Department of Pathology, University of Miami Miller School of Medicine, Miami, FL, USA., Histopathology and Molecular Diagnostics, University Hospital Careggi and University of Florence, Florence, Italy., Department of Pathology, Stanford University, Stanford, CA, USA., Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA., Department of Surgical Pathology, Aichi Medical University, Nagakute, Japan., Department of Diagnostic and Molecular Pathology, Alberta Precision Labs and University of Calgary, Calgary, AB, Canada., Centre of Cancer Biomarkers and Biotherapeutics, Barts Cancer Institute, Charterhouse Square, Queen Mary University of London, London, UK.