Testicular Torsion in a 14-Year-Old with Sertoli Cell Granular Cell Change and Sertoli Nodules

<b>Introduction:</b> Sertoli eosinophilic granular change and Sertoli cell nodules are incidental findings. This details focal Sertoli eosinophilic granular and Sertoli cell only changes coincident with Sertoli cell nodules in a pubertal testis with acute torsion and bell clapper deformity. <b>Case Report:</b> A 14-year-old with bell clapper deformity underwent orchiectomy for torsion. There was acute interstitial hemorrhage. Seminiferous tubules contained only Sertoli cells in ∼10%, 2-5% of tubules demonstrated eosinophilic granular cell changes. There were several Sertoli cell nodules. <b>Discussion:</b> Sertoli cell nodules and eosinophilic granular change have not been described together. The focality of Sertoli cell only changes is unusual. The combination of focal Sertoli cell only and eosinophilic granular cell changes with Sertoli nodules in a testis with bell clapper abnormality may reflect an abnormal testicular environment, either physical and/or molecularly. This combination raises concerns for future fertility if seminiferous tubular abnormalities exist and progress in the remaining testis.