Bilateral asynchronous Sertoli cell tumor in a boy with the Peutz-Jeghers syndrome

A rare type of Sertoli cell tumor with features of a large cell calcifying Sertoli cell tumor and a sex cord tumor with annular tubules developed in a boy with the Peutz-Jeghers syndrome. A similar tumor had been removed from the contralateral testicle 9 years previously. The clinical and pathological findings in our case are compared to 3 similar cases reported in the literature.

Oxyphilic Sertoli cell tumor of the ovary: a report of three cases, two in patients with the Peutz-Jeghers syndrome

Three women, aged 19, 21, and 30 years, two with the Peutz-Jeghers syndrome (PJS), had unilateral ovarian tumors composed of Sertoli cells with abundant eosinophilic cytoplasm. Electron microscopical and immunohistochemical examinations in one case supported the diagnosis of a sex cord tumor. Two patients are well 3 and 20 months postoperatively; the third was well for 15 years when recurrent tumor involving multiple intraabdominal sites was discovered. The occurrence of two of these tumors in patients with PJS and the known increased frequency of sex cord tumors in patients with this syndrome indicate an association. Sertoli cell tumor should be included in the differential diagnosis of oxyphilic ovarian tumors, particularly if there is a tubular pattern.

[Sertoli-Leydig tumors in children. 2 case reports]

Sertoli-Leydig tumors stem from the mesenchyma and sexual cords of the embryonic gonad. Two cases are reported. One manifested as symptoms of virilization in a 12 year old girl. The other patient developed adnexal torsion at the age of five years. Pelvic ultrasonography visualized the tumor in both cases. Increased production of ovarian androgens suggested the diagnosis in the first case. Histological studies disclosed intermediate differentiation in the first case and tubular differentiation in the second. These tumors usually exhibit low-grade malignancy and unilateral salpingo-oophorectomy ensures recovery in most instances.

Sertoli-Leydig cell tumor of the ovary: a rare cause of amenorrhea

A 15-year-old girl presented to a primary care clinic with secondary amenorrhea, masculinization, and rapidly increasing abdominal girth. Evaluation revealed a large pelvic mass, which was found at laparotomy to be a bilateral Sertoli-Leydig cell tumor producing androgens and high levels of alpha-fetoprotein (AFP). The patient underwent bilateral salpingo-oophorectomy. Other pelvic structures were uninvolved. The postoperative course was unremarkable, with testosterone and AFP levels in the normal range. A thorough literature search revealed no cases in which bilateral Sertoli-Leydig cell tumors were associated with high AFP levels. This case was unusual in its pathology, dramatic in its presentation, and valuable in its implications regarding the work-up of amenorrhea in young women.

[Sertoli-Leydig-cell ovarian tumor with a retiform pattern and heterologous elements: a rare cause of virilization]

The case is presented of a young female with virilization signs and total circulating testosterone levels above 4 ng/ml, without a concomitant increase in cortisol, 17 OH-progesterone, DHEA-S, or androstenedion levels. On CT scan exam a tumoral mass in the left ovary was observed with polycystic characteristics similar to those observed in ovarian cystadenoma, inspite of the fact that most androgenic ovarian tumors are solid. The pathological study revealed an ovarian Sertoli-Leydig tumor associated to a reticular pattern with heterologous chondroid and mucinoid elements of cystadenoma.

Large cell calcifying Sertoli cell tumor of the testis

We report on a patient with a large cell calcifying Sertoli cell tumor of the testis and review the literature of this recently described rare subtype of Sertoli cell tumor. Twenty-one cases, including ours, have been reported in the literature. Six of twenty cases (28%) had clinically evident endocrine abnormalities and eight of twenty-one cases (38%) were bilateral. This tumor has a low malignant potential with only one patient known to have metastatic disease.

The androgen insensitivity syndrome (testicular feminization): a clinicopathologic study of 43 cases

Forty-three patients with the androgen insensitivity syndrome (AIS), ages 14 to 83 (average 27) years, were studied. Forty patients had complete AIS and three patients had incomplete AIS. Microscopic examination of the testes revealed immature tubules, which contained rare spermatogonia in 28% of the cases. Prominent Leydig cells and a spindle-cell stroma resembling ovarian stroma were found in a majority of cases. The organization of the testicular parenchyma could be classified into one of four patterns: diffuse tubulostromal, lobular tubulostromal, mixed tubulostromal, or stromal-predominant. Hamartomas were present in 63% and Sertoli cell adenomas in 23% of the cases. Malignant tumors developed in 9% of the patients and comprised two seminomas, one intratubular germ cell neoplasm with early stromal invasion, and a malignant sex cord tumor. At least one fallopian tube was present in 35% of the cases.

Ollier's disease associated with ovarian Sertoli-Leydig cell tumor and breast adenoma

An ovarian Sertoli-Leydig cell tumor in a 15-year-old girl is reported. The patient had enchondromatosis (Ollier's disease), and a review of the literature revealed a few previous reports linking enchondromatosis with ovarian sex-cord stromal tumors. This association between these two unusual lesions indirectly supports a generalized mesodermal dysplasia in patients with enchondromatosis.

Sertoli-Leydig cell tumor associated with a mature cystic teratoma in a single ovary

Sertoli-Leydig cell tumors of the ovary are rare neoplasms of young women and are best known for their frequent virilizing effects. They have very rarely been reported in association with other ovarian neoplasms. We report such a tumor associated with a mature cystic teratoma in the same ovary. The wide variety of histologic patterns seen in many Sertoli-Leydig cell tumors including the present case, often causing difficulty in diagnosis, is reviewed.

An unusual hormone pattern in a virilized woman affected by Sertoli-Leydig cell tumor. Report of a case

A 24-year-old woman was admitted to hospital because of hirsutism, virilism and amenorrhea, which had appeared 6 months earlier. Endocrinological evaluation showed a slightly elevated serum level of testosterone (1.2 +/- 0.05 ng/ml), normal plasma levels of dehydroepiandrosteronesulfate (DHEA-S) (2,070 +/- 6 ng/ml), androstenedione (1.8 +/- 0.5 ng/ml) and sex hormone-binding globulin (SHBG)(42 +/- 3 nM/L); there was normal urinary 17-ketosteroid (17-KS) excretion (11.7 mg/24 h), low urinary estrogen (E) excretion (3 +/- 0.4 micrograms/24 h), suppressed basal gonadotropin concentrations (LH 0.9 microUI/ml; FSH 3.2 microUI/ml) and an exaggerated response to the LH-RH test. At laparotomy, a monolateral ovarian tumor was found, which was proved histologically to be a Sertoli-Leydig cell tumor. After tumor ablation, a regular menstrual cycle followed and progressive reduction of virilism was noted. This was followed within 4 months by complete normalization of LH, FSH, estrogen and progesterone serum levels. The responsiveness to LH-RH also became normalized. Two years after this operation, the patient had a normal pregnancy. This case of virilization in a woman affected by a benign Sertoli-Leydig cell tumor was primarily characterized by an unusual response of the hypothalamopituitary axis against an endocrinological background of notable alteration of the androgen/estrogen ratio, where the androgens were slightly increased and the estrogens greatly reduced.

Colliculus seminalis as a cause of a urethral filling defect in two dogs with Sertoli cell testicular neoplasms

A urethral filling defect in the proximal portion of the pelvic urethra, suggestive of a mass, was detected by positive-contrast retrograde urethrography in 2 dogs with prostatic disease and Sertoli cell neoplasms. Extension of prostatic neoplasia into the urethra or primary urethral neoplasia were considered as explanations for the radiographic finding of an intraluminal filling defect in the pelvic urethra. Masses were visualized and biopsied during prostatic surgery. Masses were nonneoplastic and represented enlargement of the colliculus seminalis.

Prostatic cyst and concurrent Sertoli cell tumor in a dog

Two large prostatic cysts were found in a dog that had a Sertoli cell tumor in an abdominal testis and other signs of hyperestrogenism, including feminization, dermatologic alterations, and slight anemia. After marsupialization of the cysts and removal of the testes, the clinical signs resolved. Evidence of metastasis was not observed after one year. Although tumor-induced hyperestrogenism has been postulated as a cause of prostatic cysts in the dog, clinical reports of such cases are few.

Testicular tumors with Peutz-Jeghers syndrome

The case of a 6-year-old boy with Peutz-Jeghers syndrome (PJS), gynecomastia, and multifocal and bilateral testicular tumors is described. Females with PJS are known to be at increased risk for developing gonadal tumors. This case and other reports from the literature suggest that males, as well as females, with PJS are at risk for developing gonadal tumors.

Resistant hypertension associated with a renin-producing ovarian Sertoli cell tumor

A 17-year-old girl with refractory, but nonmalignant, hypertension and hypokalemia is presented. A state of primary hyperreninism and secondary hyperaldosteronism was found to exist, together with a renin-producing Sertoli cell ovarian tumor. Upon removal of the tumor, this patient attained both a normotensive and a normokalemic state. A brief review is given of renal and nonrenal renin-producing tumors.

Arrested puberty associated with a Sertoli-Leydig cell tumor

Androgen-producing ovarian tumors are rarely recognized as a cause of delayed or arrested puberty, despite their frequent association with secondary amenorrhea in the older patient. A case is discussed of a Sertoli-Leydig cell tumor in an 18-year-old girl resulting in arrest of breast development and primary amenorrhea.

A testicular tumor resembling the sex cord with annular tubules in a case of the androgen insensitivity syndrome

Sex cord tumor with annular tubules (SCTAT) is a distinctive neoplasm with indifferent cells of sex cord derivation in a characteristic arrangement of ring-like tubules. Much attention has been drawn to its association with the Peutz-Jeghers syndrome (PJS) with reported occurrence of the tumor in the testis of a boy with PJS. The authors present two cases of the androgen insensitivity syndrome (AIS), one of the cases being distinctive in having a large multicystic tumor resembling the SCTAT in the immature gonad. Additionally, the focal areas of the tumor, the large Sertoli cells lining the tubules, resembled those of a large cell calcifying Sertoli cell tumor (LCCSCT) although no calcific areas were discernible. Although the occurrence of neoplasms like germinomas and tubular adenomas is well known in the AIS, SCTAT has hitherto not been reported in a gonad of the AIS. SCTAT has been placed under an "unclassified sex cord-stromal" category in the World Health Organization (WHO) Classification, yet, opinions are divided as to its origin from a granulosa or Sertoli cell, although an overlap in the histologic features of the two cell categories is to be anticipated in view of their homologous nature. In the case presented, the close resemblance of the tumor cells to the Sertoli cells of the uninvolved gonad would further support the concept of a Sertoli line of differentiation of the SCTAT.

Large cell calcifying Sertoli tumor of the testis. Light microscopic and ultrastructural study

Large cell calcifying Sertoli tumor of the testis was found in a 16-year-old boy who had presented with gynecomastia. Serum estrogen level, which had been elevated preoperatively, returned to normal following orchiectomy. Charcot-Bottcher crystalloids are demonstrated in the neoplastic Sertoli cells.

Ovarian Sertoli cell tumors: a report of 10 cases

Ten Sertoli cell tumors of the ovary, which occurred in patients from 2 to 62 years of age (average 38 years), are reported. Two prepubertal patients presented because of isosexual precocity, and there was evidence of estrogenic stimulation of the endometrium in two postmenopausal women. The tumors were all Stage Ia and ranged from 0.8 to 17 cm in diameter. On microscopic examination five of them contained tubules that were predominantly hollow, and five, tubules that were predominantly solid. Two of the neoplasms in the latter group were of the lipid-rich type. Seven tumors were well differentiated, two were of intermediate differentiation, and one was poorly differentiated. The last tumor, which metastasized widely and was rapidly fatal, was the only clinically malignant tumor in the series.

Sertoli-Leydig cell tumor of the ovary producing alpha-fetoprotein

A 16-year-old girl with virilization and elevated serum alpha-fetoprotein (AFP) levels was found to have a Sertoli-Leydig cell tumor of the ovary. Immunoperoxidase studies using anti-AFP localized AFP in cells with the histologic appearance of Leydig cells. Serum AFP fell to undetectable levels after excision of the tumor. The patient is alive and well 1 year postexcision.

Sertoli cell tumour in a true hermaphrodite: suggestive evidence for ectopic gonadotrophin production by the tumour. Case report

A Sertoli cell tumour that occurred in a true hermaphrodite with a 46, XX chromosome constitution is described. Removal of the tumour was followed by an immediate fall in plasma FSH and LH concentrations. It is suggested that the tumour possessed the capacity for ectopic production of the gonadotrophins.

Leydig-Sertoli cell tumour in the postmenopausal female. A case report

A patient with a Leydig-Sertoli cell tumour of the ovary is described. This rare lesion coexisted with three other primary neoplastic lesions, namely an adenocarcinoma of the colon, an ovarian fibroma, and leiomyomas of the uterus. A discussion of the unusual ovarian lesion and a short review of the literature are presented.

Prostatic adenocarcinoma with concurrent Sertoli cell tumor in a dog

A case of metastatic prostatic adenocarcinoma with concurrent Sertoli cell tumor is presented in an old, miniature Schnauzer dog. The prostatic neoplasm was highly anaplastic and had metastasized widely. Clinical signs were compatible with increased estrogen production. It is interesting to note that the prostatic carcinoma, usually considered to be androgen dependent, developed and metastasized, despite the presence of apparently increased estrogen levels.

Sertoli tumors of the ovary. A clinicopathologic study of 28 cases with ultrastructural observations

The clinical and pathologic features of 28 Sertoli tumors of the ovary are presented. Seventeen of the 18 neoplasms had a functional effect. The effects were hyperestrinism (eight women), isosexual precocious puberty (three girls), virilization (four women), a progestational decidual reaction on the peritoneum (one woman), and a combination of virilizing and estrinizing signs (one woman). There were three histologic patterns: simple tubular, complex tubular, and folliculome lipidique. Two neoplasms recurred, both of which had the distinctive feature of invasion of the supporting stroma by individual and columns of tumor cells in the original tumors. Electron microscopic evaluation of three neoplasms disclosed. Charcot-Böttcher filaments unequivocally identifying the Sertoli differentiation of the predominant cells in the neoplasm. The identification by electron microscopy of a smaller population of cells within the three tumors similar to typical ovarian stromal cells suggests that Sertoli tumors arise from ovarian stromal cells.

Peutz-Jeghers syndrome with feminizing sertoli cell tumor

A case involving a 6-year-old boy with Peutz-Jeghers syndrome and an unilateral feminizing Sertoli cell tumor is described. Endocrinologic studies revealed consistently high plasma and urine levels of estrogens and normal levels of testosterone and dihydrotestosterone. The increased levels of estrogens did not show changes that could be correlated with exogenous gonadotropin administration, thus indicating an autonomous nature. The histopathologic studies of nontumorous testicular tissue revealed changes in the seminiferous tubules which suggested that estrogens, directly or indirectly, may have had both stimulating and atrophying effects. It is concluded that gonadal tumors are in additional manifestation of the Peutz-Jeghers syndrome gene in both male and female patients.

A cohort study of canine testicular neoplasia

A prospective epidemiologic study of canine testicular neoplasia was undertaken in the Philadelphia area in 1971, with the cooperation of private veterinary practitioners. By the end of 1975, 938 dogs had been monitored for an average of 2 years. The cohort consisted of 609 cryptorchid and 329 age- and breed-matched controls. The incidence of testicular neoplasia in the cryptorchid subcohort was 12.7/1,000 dog-years at risk. Testicular neoplasms did not develop in controls. A large proportion of the dogs were below the average age at onset for this neoplasm. Among dogs over 6 years of age, the incidence was 68.1/1,000 dog-years at risk. The incidence of Sertoli cell tumors and seminoma was approximately twice as high in dogs with unilaterally retained inguinal testicles as in abdominal cryptorchids. Sertoli cell tumors developed in 10 dogs and seminoma developed in 6. One half of the testicular neoplasms that developed did so within the first year of observation. This study demonstrated the feasibility of conducting prospective epidemiologic studies of canine diseases with the assistance of practicing veterinarians.

Concentration of radiolabeled cholesterol in a feminizing adenoma of the testis

Quantitative tissue studies demonstrated increased 19-[131I]-iodocholesterol concentration in a feminizing adenoma of the testis. The potential application of iodocholesterol and its isomers in the detection of steroid-secreting neoplasms of the testis and ovary is suggested.

Giant sertoli cell adenoma in testicular feminization syndrome

An extremely large Sertoli cell adenoma discovered incidentally in an elderly phenotypically femal patient with testicular feminization syndrome is reported. The patient is alive 3 years following removal of the tumor.

Sertoli cell tumour with gynaecomastia

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