AIMS: Sex cord stromal cell tumours (SCSCT) are a rare subset of testicular tumours, the majority of which are benign but a small proportion can be malignant. It has been demonstrated that certain histopathological risk factors can be useful in identifying those with malignant potential. However currently the absence of pathological risk factors is not used to exclude malignancy and this study aimed to investigate whether patients with one or fewer risk factors would relapse. We aim to confirm the hypothesis that no patient with one or fewer identified pathological risk factors predicting malignancy will develop metastatic disease. MATERIALS AND METHODS: This was a retrospective analysis of all patients from a single centre with a diagnosis of SCSCT over a 20-year period. Cases were reviewed for the presence or absence of risk factors. Relapse rates and overall survival between the groups with and without risk factors were compared using a Kaplan-Meier analysis. RESULTS: 76 SCSCTs were identified, of which 56 were deemed low-risk due to the presence of one or fewer pathological risk factors predictive of malignancy. None of the 56 patients relapsed with metastatic disease and, when compared with the 20 patients who had 2 or more risk factors for malignancy, relapse rates were significantly higher (p <
0.0002) and overall survival lower (p = 0.0003) in those who had risk factors. A key limitation is our sample size. CONCLUSION: These findings, supported by the available literature on SCSCTs, suggest that malignancy can be accurately predicted based on pathological findings. There is potential that these findings can be used to tailor follow up of low-risk patients accordingly.