Purpose:To evaluate pathologic variables of testicular sex cord–stromal tumors (TSCST), management options, and clinical outcomes.Methods: We performed a retrospective review of 48 patients with TSCST treated at Memorial Sloan-Kettering Cancer Center between 1997 and 2012. Clinical outcomes were compared based on treatment and previously described pathologic factors associated with metastatic potential. Results:Of 48 patients, 37 underwent surveillance without retroperitoneal lymph node dissection, 34 having 0 high-risk features and 3 having 1 high-risk feature. Median follow-up was 14.5 months (IQR 6.9 – 32.5 months); no patients experienced recurrence.Retroperitoneal lymph node dissection was performed in 11 patients, 6 with clinical stage 1 disease and ≥2 high-risk features who underwent early dissection, 2 with clinical stage IIa disease at diagnosis who underwent early dissection, 3 with clinical stage 1 disease and ≥2 high-risk features were observed by outside clinicians but were referred to our institution for retroperitoneal disease. Six patients with clinical stage 1 disease underwent early dissection, 4 had no evidence of disease with median follow-up of 6.6 years, 2 recurred and died of disease. Of the 2 patients with IIa disease at diagnosis, neither relapsed. Of the 3 patients with delayed dissections all 3 relapsed and 1 died of disease. Conclusions:Patients with TSCST and ≤1 high-risk feature can be safely observed without retroperitoneal lymph node dissection, though longer follow-up is needed. Given lack of effective alternative treatments, early retroperitoneal lymph node dissection for patients with ≥2 high-risk features or clinical stage IIa disease may be beneficial.