An immunohistological study of steroid localization in Sertoli-Leydig tumors of the ovary and testis

Use of novel serum markers in clinical follow-up of Sertoli-Leydig cell tumours

BACKGROUND

Sertoli-Leydig cell tumours of the ovary account for only 0.2% of malignant ovarian tumours. Two-thirds of all patients become apparent due to the tumour's hormone production.

METHODS

A 41-year-old patient (gravida 4, para 4) presented with dyspnoea, enlarged abdominal girth and melaena. Diagnostic imaging was suspicious for an ovarian cancer. The standard tumour marker for ovarian cancer (CA 125) was elevated to 984 U/mL.

RESULTS

Surgical exploration of the abdomen revealed a mouldering tumour of both adnexes extending to the level of the navel. Frozen sections showed an undifferentiated carcinoma of unknown origin. Radical surgery was performed. The final histological report described a malignant sex-cord stroma tumour, a Sertoli-Leydig cell tumour, emanating from both ovaries. Analysis of preoperative blood serum showed elevated levels of CYFRA 21-1 (10.4 ng/mL), neuron-specific enolase (36.2 ng/mL), oestradiol (485 pg/mL) and CA-125 (984 U/mL). Adjuvant chemotherapy and regional hyperthermia were performed due to the malignant potential and incomplete resection of the tumour.

CONCLUSIONS

Undifferentiated Sertoli-Leydig cell tumours show a poor clinical course. As only two-thirds of patients with this rare disease present with elevated hormone levels, new markers deserve further investigation to offer more specific, individualised tumour monitoring.

Sertoli-Leydig cell tumor - a rare androgen secreting ovarian tumor in postmenopausal women. Case report and review of literature

Sertoli-Leydig cell tumors (SLCT) constitute only 1-0.5% of all primary ovarian neoplasms. We report a SLCT in a postmenopausal woman aged 69 years. The physical examination revealed severe hirsutism. Basal hormonal evaluation showed high plasma testosterone and estradiol values, with suppressed plasma gonadotropins. Computer tomograph scan revealed a right ovarian tumor mass of 4,3/3 cm, confirming an androgen secreting ovarian tumor. The histopathological and immunocytochemical examination established the diagnosis of well differentiated Sertoli-Leydig cell tumor. The tumor was positive for cytokeratin KL 1 and S-100 protein and, in isolated tumor cells, positive for alpha-fetoprotein. Postsurgical evolution was favorable; controls after 6 months and 3,5 years showed marked reduction of hirsutism, normal plasma testosterone values and gonadotropins in normal postmenopausal range. We discuss the complex aspects of etiology and pathogenesis, the clinical and hormonal settings, the role of immunocytochemical markers in diagnosis, as well as the therapy and the prognostic features of this ovarian tumor.

Immunohistochemical study of testicular sex cord-stromal tumors, including staining with anti-inhibin antibody

Inhibin is a peptide hormone produced by ovarian granulosa cells and testicular Sertoli cells. Ovarian granulosa cell and other sex cord-stromal tumors usually exhibit positive immunohistochemical staining with antiinhibin antibodies, and this may be valuable in differentiating these neoplasms from histologic mimics. In the present study, we investigated the immunohistochemical staining of testicular sex cord-stromal tumors using antiinhibin. Immunostaining with CAM5.2, vimentin, S-100 protein, desmin, epithelial membrane antigen (EMA), carcinoembryonic antigen (CEA), and placental alkaline phosphatase (PLAP) also was performed because few studies have investigated in detail the immunophenotype of testicular sex cord-stromal tumors. Fifteen of 16 Leydig cell tumors exhibited strong positive staining with antiinhibin. A proportion of Leydig cell tumors also stained positively with CAM5.2 (7 of 16), vimentin (14 of 16), S-100 protein (10 of 16), desmin (2 of 16) and epithelial membrane antigen (4 of 16). Four of six testicular sex cord-stromal tumors with varying degrees of Sertoli or granulosa cell differentiation were positive with antiinhibin, as were two of three sex cord-stromal tumors that were unclassified. Some of these tumors were positive with CAM 5.2, vimentin, S-100 protein, desmin, and epithelial membrane antigen. All tumors were negative with carcinoembryonic antigen and placental alkaline phosphatase. The immunohistochemical findings show that, analogous to their ovarian counterparts, most testicular sex cord-stromal tumors are immunoreactive with antiinhibin. Immunohistochemistry using this antibody as part of a panel may be valuable in confirming a diagnosis of testicular sex cord-stromal tumor and in differentiating these neoplasms from others that may mimic them.

Inhibin immunohistochemistry applied to ovarian neoplasms: a novel, effective, diagnostic tool

Immunohistochemistry using monoclonal antibodies against human inhibin, a peptide hormone produced by ovarian granulosa cells to inhibit follicle-stimulating hormone (FSH), has been recently applied to diagnostic anatomic pathology. This investigation hypothesizes that inhibin immunohistochemistry will aid in the crucial clinical distinction between sex cord-stromal and other primary ovarian neoplasms. Available H&E slides and clinical information from a retrospective surgical series of 186 primary ovarian tumors were reviewed to verify diagnoses, and representative paraffin sections were immunostained with anti-inhibin (R1 monoclonal, Serotec, Kidlington, Oxford, UK). Immunoreactivity was graded as weak/strong (W/S), and the proportion of strong staining cells was coded as follows: S1 = <10%, S2 = 10%-50%, S3 = >50%, respectively. Inhibin immunoreactivity for 137 sex cord-stromal lesions was as follows: 100% of 66 granulosa cell tumors: 80% S3, 20% S2; 100% of 17 Sertoli-stromal tumors: 90% S3, 10% S2; 100% of 13 hyperplastic follicular/stromal lesions: 90% S3, 10% S2; 100% of six steroid cell tumors: 100% S3; 90% of 18 thecomas: 40% S3, 10% S2, 10% S1, 30% W; 0% of 12 fibromas, three myxomas, and two sclerosing stromal tumors. None (0 of 49) of the other ovarian neoplasms exhibited inhibin: 22 carcinomas, 12 carcinosarcomas, seven small cell carcinomas, six germ cell tumors, and two lymphomas. In the typical case, the distinction between sex cord-stromal and other ovarian neoplasms requires nothing more than routine pathological examination. In diagnostically challenging cases, our data indicate that inhibin immunohistochemistry is a very useful adjunct because granulosa and sertoli-stromal tumors are positive whereas other potential mimickers have been negative thus far.

Ovarian tumors with functioning manifestations

Various categories of ovarian tumors, particularly those of gonadal stromal origin, are capable of producing a variety of hormones that occasionally induce interesting clinical manifestations. The endocrine manifestations associated with gonadal stromal tumors are often due to hormone production by the tumor cells. Sometimes the tumor cells produce only one hormone, while more frequently the hormonal manifestations result from a summation of various hormones including transformation of a variety of prehormones produced by different components of the tumor including its supportive or reactive stroma. The mechanisms involved in the production and transformation of various hormones and prehormones are complex and not thoroughly established at this time. This review will focus on gonadal stromal tumors and discuss evidence available for linkage of the clinical manifestations to hormones produced by the various neoplasms.

Functional pathology of human ovarian steroidogenesis: Normal cycling ovary and steroid-producing neoplasms

In human reproductive endocrinology and pathology, it is important to localize the sites of steroid hormone production to obtain a better understanding of steroid metabolism. Previous approaches, including morphological and biological studies, could not sufficiently demonstrate which cells produce what steroids in both normal and pathological human ovaries. Recent development of immunohistochemistry and in situ hybridization of the enzymes specifically involved in sex steroid biosynthesis made it possible to detect the expression of steroidogenic enzymes, and subsequently the sites of specific steroid production in diagnostic pathology materials. There are, however, some limitations in the approaches, including correlation of the findings with preoperative systemic hormonal manifestations in the patients with sex cord-stromal tumors of the ovary, and great care should be taken when interpreting results.

Evidence for receptors specific for 17 beta-estradiol and testosterone in chondrocyte cultures

Recently, sex hormones were shown to stimulate chondrocyte differentiation and matrix protein synthesis in vitro in a sex-specific and maturation-dependent manner. The aim of the present study was to determine whether cytosolic receptors in these cells would specifically bind 17 beta-estradiol and testosterone, and if so, whether binding was gender- and maturation-dependent. Confluent, fourth passage cultures of cells derived from male or female rat costochondral growth zone and resting zone cartilage were homogenized and specific binding of 17 beta-estradiol or testosterone measured in the cytosolic fraction. Scatchard analysis indicated the presence of a high-affinity 17 beta-estradiol receptor (Kd = 4.5 to 8.7 x 10(-11) M), with low binding capacity (3.9 to 11.2 fmol/mg protein). Chondrocytes from female rats were found to have a significantly greater binding capacity for 17 beta-estradiol than chondrocytes from male rats. However, cells from both sexes had binding capacities that were independent of cell maturation. A high-affinity testosterone receptor (Kd = 4.3 to 6.3 x 10(-11) M) with low binding capacity (4.1 to 5.9 fmol/mg protein) was found in both males and females, but no difference in binding capacity was noted, either as a function of gender or stage of cell maturation. Immunohistochemistry using antibodies against 17 beta-estradiol and testosterone and the 17 beta-estradiol nuclear receptor (D-75) confirmed that 17 beta-estradiol and testosterone receptors were present in chondrocytes from both male and female rats. These data demonstrate that chondrocytes from growth zone and resting zone cartilage are capable of binding both 17 beta-estradiol and testosterone. This suggests that these hormones mediate their direct effects on chondrocytes via receptors specific for their appropriate ligand. The sex-specific effects of 17 beta-estradiol may be due to differences in receptor number between chondrocytes derived from female and male rats. In contrast, the sex-specific effects of testosterone may be regulated at the post receptor level since no differences in binding capacity were found between males and females.

Sertoli-Leydig cell testicular tumor: case report and review of sex cord/gonadal stromal tumor histogenesis

We describe a case of well differentiated Sertoli-Leydig cell tumor in a testicle. Previously, this tumor has only been illustrated histologically. The existence of a male homologue to the female arrhenoblastoma containing Sertoli and Leydig cells again supports the current hypothesis of gonadal development, and the common steps found in the male and female pathways.

Testicular sex cord-stromal lesions: immunohistochemical analysis of cytokeratin, vimentin and steroidogenic enzymes

We have studied immunolocalization of all steroidogenic enzyme involved in sex steroids biosynthesis, P-450 side chain cleavage (P-450scc), 3 beta hydroxy steroid dehydrogenase (3 beta-HSD), P-450 17 alpha hydroxylase (P-450(17 alpha)) and P-450 aromatase (P-450arom) and that of vimentin and cytokeratin in 14 cases of testicular sex cord-stromal tumours (6 Leydig cell tumours, 5 Sertoli cell tumours, 2 fibromas and 1 granulosa cell tumour) as well as 4 cases of hyperplasia (2 Leydig and 2 Sertoli). Leydig cell tumour expressed all four steroidogenic enzymes examined, indicating that this tumour can synthesize oestrogen from cholesterol. In 2 cases of Sertoli cell tumour, the tumour cells with clear cytoplasm and without Reinke's crystals expressed P-450ssc, 3 beta-HSD and P-450(17 alpha), suggesting the capability of androgen production in these tumour cells. Fibromas and granulosa cell tumour were negative for the enzymes examined. In immunohistochemistry of intermediate filaments, Leydig cell tumours demonstrated only vimentin. Sertoli cells in hyperplasia and non-neoplastic testis expressed only vimentin but Sertoli cell tumours expressed both cytokeratin and vimentin. Cytokeratin immunoreactivity was correlated with morphological epithelial differentiation in Sertoli cell tumour. These findings in testicular Sertoli cell tumour are considered to represent the multiple differentiation capacity of this neoplasm. Immunohistochemical study of steroidogenic enzymes and intermediate filaments provided new insight into neoplastic steroidogenesis and the differentiation capacity of testicular sex cord-stromal neoplasms.

Leydig cell tumor of the testis: a case diagnosed by fine-needle sampling without aspiration with histologic, immunohistologic, and electron microscopic analysis

Fine-needle sampling without aspiration was performed in a patient with a testicular mass. The cytologic diagnosis was consistent with Leydig cell tumor. Cytologic features included abundant grey-blue cytoplasms with spherical or oval nuclei in May-Grünwald-Giemsa-stained smears. Intranuclear inclusions were observed but no Reinke's crystals were detected. Histologic findings confirmed the diagnosis and tumor cells were positive for vimentin. Electron microscopic analysis of the tumor showed abundant smooth endoplasmic reticulum and mitochondria with tubulovesicular cristae but no Reinke's crystals.

Hormone-producing tumors of the ovary

The ovary is an endocrine organ that gives rise to a wide variety of neoplastic and tumorlike nonneoplastic conditions, some of which are associated with endocrine activity. The hormones produced may be steroidal or nonsteroidal. The ovary is unique among endocrine organs in reacting to the presence of nonendocrine tumors within it by abnormal or inappropriate production of sex steroidal hormones. A classification of hormone-producing ovarian lesions is proposed based on the World Health Organization's histologicai typing of ovarian tumors.

LR White embedding allows a multi-method approach to the analysis of brain tissue from patients with Alzheimer's disease

Light (LM) and electron (EM) microscope comparisons of the cytochemistry and immunocytochemistry of neuritic plaques and neurofibrillary tangles, the main histopathological changes in the brains of Alzheimer's disease sufferers, have been almost impossible because of the disparity between the two technologies. By embedding unosmicated brain tissue in the acrylic resin LR White, direct comparisons can be made between techniques applied at the LM level with those at the EM level. After partial dehydration in 70% ethanol, the tissue is embedded by rapid infiltration and polymerization at 0 degrees C, which has been shown to maximally preserve tissue immunoreactivity. Semithin sections are then receptive to routine LM stains, silver stains e.g. Gomori's methenamine silver, and immunocytochemistry with immunoperoxidase or immunocolloidal gold. Serial thin sections are stable in the EM and can be immunolabelled and directly compared with their LM counterparts. Results from the use of a mouse monoclonal antibody against beta-amyloid and a rabbit polyclonal antibody against ubiquitin are presented. LR White resin includes no elements other than carbon, oxygen and nitrogen, of which it is composed, so that sections of it are valuable for sensitive X-ray energy dispersive microanalysis.

Feasibility of the immunohistochemical detection of endogenous steroids in paraffin-embedded ovarian tumours

Formalin-fixed, paraffin-embedded samples from 25 ovarian granulosa cell tumours and six poorly differentiated ovarian carcinomas were examined immunohistochemically for the presence of estradiol, testosterone and progesterone. Twenty-four of the 25 granulosa cell tumours stained for estradiol predominantly in granulosa cells and also in the theca cells, but none of the carcinomas were positive. All the granulosa cell tumours and five out of six carcinomas were positive for progesterone, while 13 granulosa cell tumours and three carcinomas stained moderately positive for testosterone. No clear-cut relationship was observed between positivity for estradiol in granulosa cell tumours and occurrence of endometrial hyperplasia. In two cases of granulosa cell tumours, 1-15% cells showed ultrastructural features of steroid synthesis: i.e. moderate to abundant smooth endoplasmic reticulum and mitochondria with tubular cristae. This is in contrast with the diffuse immunohistochemical staining reaction of granulosa cell tumours with antisteroid antibodies. To evaluate the significance of immunohistochemical reactions for estradiol, four estradiol-containing tumours were tested by radioimmunoassay for the presence of estradiol before and after dehydration. As expected, treatment with organic solvents leads to a drastic reduction in estradiol content below the detection level of the assay. The results indicate that immunohistochemical staining for steroids of paraffin-embedded granulosa cell tumours is of limited value.

Seasonal changes in serum gonadotropin, testosterone, 11-ketotestosterone, and estradiol-17 beta levels and their relation to tumor burden in gonadal tumor-bearing carp x goldfish hybrids in the Great Lakes

The hybrids of carp (Cyprinus carpio) and goldfish (Carassius auratus) collected from the lower Great Lakes between 1978 and 1981 exhibited a high frequency of gonadal neoplasms and apparent sterility, conditions which were rare in the parental species. A pronounced hyperplasia of gonadotropic cells in hybrids resulted in the accumulation of large stores of biologically active gonadotropin (GtH) in the pituitary gland. Serum GtH levels were generally higher in hybrids than in carp collected from the same areas, but seasonal trends were similar for both species. Among hybrids, tumored individuals had higher serum GtH levels than nontumored individuals. Serum levels and seasonal trends for testosterone (T), 11- and ketotestosterone (11-KT), and estradiol-17 beta (E2) were, for the most part, similar when carp and nontumored hybrids of the same gender were compared. Serum levels of T and 11-KT (but not E2) were generally higher in tumored hybrids when compared to nontumored individuals. High serum steroid levels were related to a specific tumor type, possibly of Sertoli cell origin. Although the etiology of the gonadal tumors is not yet known, the serum levels of gonadal steroids in hybrids make it unlikely that a lack of steroidal feedback is responsible for the gonadotrop hyperplasia.

What's new in the localization of sex steroids in the human ovary and its tumors?

It is important to understand the distribution of steroidogenesis in steroid producing tissues in order to obtain a better understanding of steroid metabolism. Recent advances in purification and subsequent generation of antibodies against cytochromes P-450 specific for steroid hormone biosynthesis have made it possible to localize the sites of steroidogenesis immunohistochemically. This review provides the localization of sex-steroid hormone biosynthesis in normal and pathological human ovaries including sex-cord stromal tumors, hyperthecosis and Brenner tumor, as determined by the tissue distribution of immunoreactivity of individual enzymes specific for different stages of the biosynthetic process.

Steroid biosynthesis in the Sertoli-Leydig cell tumor: effects of insulin and luteinizing hormone

In vitro steroid production by a virilizing Sertoli-Leydig cell tumor of the ovary was studied. For comparison, stromal tissue from the opposite normal ovary was also incubated under similar conditions. The tumor fragments secreted significantly more testosterone (527 +/- 168 versus 48 +/- 29 pg/mg tissue, p less than 0.001), androstenedione (1188 +/- 400 versus 40 +/- 10 pg/mg tissue, p less than 0.001), and dehydroepiandrosterone (419 +/- 132 versus 73 +/- 25 pg/mg tissue, p less than 0.004) than that of normal ovarian stroma. Measurement of steroids in the ovarian venous serum draining the tumor indicated a peripheral ovarian gradient for both delta 4 and delta 5 steroids. Incubation of tumor fragments with luteinizing hormone alone resulted in a significant increase in the secretion of androstenedione and dehydroepiandrosterone (p less than 0.05). Addition of insulin to luteinizing hormone resulted in significantly greater release of androstenedione than that of treatment with luteinizing hormone alone (p less than 0.04). Addition of insulin had no effect on the release of dehydroepiandrosterone. Luteinizing hormone and insulin, either alone or in combination, failed to produce any change in the secretion of testosterone. We conclude that (1) increased testosterone secretion by Sertoli-Leydig cell tumor resulted from increased availability of precursors from both delta 4 and delta 5 pathways; (2) the tumor was responsive to luteinizing hormone with an increase in the secretion of androstenedione and dehydroepiandrosterone; (3) insulin acts synergistically with luteinizing hormone to increase secretion of androstenedione; (4) the tumor has specific binding sites for insulin; and (5) the increased levels of insulin and luteinizing hormone in polycystic ovarian disease may play a role in the pathogenesis of Sertoli-Leydig cell tumor.

Immunohistochemical studies of steroidogenic enzymes (aromatase, 17 alpha-hydroxylase and cholesterol side-chain cleavage cytochromes P-450) in sex cord-stromal tumors of the ovary

Aromatase, 17 alpha-hydroxylase, and cholesterol side-chain cleavage P-450 cytochromes (P-450AROM, P-450(17 alpha,) and P-450SCC, respectively) were immunohistochemically localized in nine granulosa cell tumors, 15 thecomas, ten Sertoli-Leydig cell tumors, two steroid cell tumors, five fibromas, and five sclerosing stromal tumors. In the thecomas, P-450SCC and P-450(17 alpha) were positive in luteinized theca cells and in cells with vacuolated cytoplasm, while P-450AROM was not observed. In the steroid cell tumors, all the P-450 cytochromes were intensely stained. P-450SCC and P-450(17 alpha) were present in cells with vacuolated cytoplasm in two cases of sclerosing stromal tumor. P-450AROM was weakly demonstrated in one of the granulosa cell tumors. P-450(17 alpha,) P-450SCC, and P-450AROM were all faintly stained in the Sertoli-Leydig cell tumors. No P-450 cytochrome immunoreactivity was observed in any fibroma.

Intraoperative ultrasound in the conservative resection of testicular neoplasms

In a series of approximately 400 patients investigated for oligospermia 4 had small testicular tumors demonstrated by high resolution real-time ultrasound. The lesions ranged in size from 3 to 6 mm., were clinically impalpable and were demonstrated on repeated sonograms. Exploration was done in all 4 patients with the aid of intraoperative high resolution ultrasound. This procedure allowed for conservative resection of the tumor with preservation of the testicle. The pathological diagnosis in all cases was benign Leydig cell tumor.

Morphology of canine ovarian Sertoli-Leydig cell neoplasms. A report of 12 cases

Of 71 dogs with primary ovarian neoplasms, 12 (17%) had Sertoli-Leydig cell tumors. Five dogs had Sertoli-Leydig cell tumors, four had pure Sertoli cell tumors, and three had Sertoli-Leydig cell tumors with a retiform pattern. Variously differentiated Sertoli cells were seen in the Sertoli-Leydig cell tumors, and one of these metastasized to the peritoneum. The pure Sertoli cell tumors were similar to these tumors in male dogs. The retiform pattern in the third group of tumors was characterized by tubuloalveolar structures resembling rete testes. Heterologous elements were seen in seven tumors (58%)--enteric glands in three Sertoli-Leydig cell tumors and one Sertoli-Leydig cell tumor with retiform pattern, and neuroendocrine carcinoma in one pure Sertoli cell tumor and two Sertoli-Leydig cell tumors with retiform pattern. The uterus was examined in seven dogs, and six (87%) had endometrial hyperplasia.

Ovarian and peripheral steroid hormones in a case of Sertoli-Leydig cell tumor

The clinical course, histology, and steroid secretion of a 59-year-old postmenopausal woman with a 4-yr history of virilizing well-differentiated Sertoli-Leydig cell tumor of the right ovary are reported. Hormone secretion was examined by measuring peripheral and ovarian venous gradients and pre-and postoperative levels of some delta 4 and delta 5 steroids, estrogens, gonadotropins and Sex Hormone Binding Globulin levels. The preoperative responsiveness to ACTH, dexamethasone and hCG is also reported. The results are consistent with a Sertoli-Leydig cell tumor producing mainly testosterone and, to a lesser degree, androstenedione, progesterone, estrone and 17 alpha-hydroxyprogesterone. The tumor hormone secretion may be in part responsive to hCG.

Endocrine and morphological study of a case of ovarian sex-cord tumor with annular tubules in a woman with Peutz-Jeghers syndrome

A bilateral ovarian sex-cord tumor with annular tubules (SCTAT) was incidentally discovered in an amenorrheic patient with Peutz-Jeghers syndrome during conservative surgery in which a small non-capsulated mass was removed from each ovary. Ovulation was then induced over two consecutive cycles with urinary gonadotropins; the couple did not conceive because of a male infertility factor. Hysterectomy and bilateral oophorectomy were performed to prevent recurrence and avoid the possibility of a cervical malignant adenoma. Immunohistochemistry of the SCTAT showed positivity for estradiol and testosterone similar to that of Sertoli and granulosa cell tumors; progesterone was not detected in any cellular component of the neoplasia. Electron microscopy showed that the neoplasm consisted of numerous solid cords of cells surrounded by fibrillary layers of basal lamina, as well as central hyaline bodies. Two types of cells, clear and dark, were noted; clear cells were predominant and intermixed with scattered dark cells. No crystalloids or Charchot-Bottcher filaments were detectable in the tumors.

Localization and distribution of unconjugated steroid hormones in normal placenta at term

The localization and distribution of unconjugated oestrone, oestradiol-17 beta, oestriol and progesterone were studied in normal term placentae, using subcellular fractionation and indirect immunofluorescence techniques. Radioimmunoassay of these steroids in each subcellular fraction showed that they were detectable mainly in the cytosol fraction. The efficiency of fixatives for retaining steroids in placental tissue during immunohistochemical procedures was studied in order to validate the present experimental techniques. As compared with other fixatives, glutaraldehyde solution produced minimal leakage of steroid hormones from placental tissue. Using an indirect immunofluorescence technique oestrone, oestriol and progesterone were detectable in the cytoplasm of villous syncytiotrophoblast of fixed term placentae.

Progesterone secreting Sertoli cell tumor of the ovary

A 33-year-old woman presenting with secondary amenorrhea and galactorrhea was found to have a Sertoli cell tumor of the ovary. The neoplasm also had a sex cord tumor with annular tubules (SCTAT) component. Further investigations revealed that in many respects the patient was endocrinologically pregnant. She had markedly elevated serum estrogen and progesterone levels and the endometrium demonstrated pronounced decidualization, but there was no evidence of actual pregnancy. Estrogen and progesterone were demonstrated by immunohistochemistry to be present in both the Sertoli cell and SCTAT portions of the tumor.

Neonatal gonadal stromal tumor of the testis: limitations of tumor markers

We report case 10 of a gonadal stromal tumor of the testis in a neonate. This tumor may occur in the testis or ovary, and is defined as a tumor of any of the specialized supporting structures of the male or female gonad. All neonatal tumors reported to date have been benign. The serum alpha-fetoprotein level, although elevated for adults, was within the normal range for an infant.

AFP-producing Sertoli-Leydig cell tumor of the ovary

A tumor of the right ovary in a 21-year-old single woman is reported. Secondary amenorrhea, hirsutism, acne and deepening of the voice were associated with the tumor. Light and electron microscopic examinations showed that the tumor was composed of cells resembling Sertoli and Leydig cells of the testis in their cytology features and growth patterns. High levels of circulating dehydroepiandrosterone, androstenedione, testosterone and alpha-fetoprotein (AFP) were found preoperatively. Preoperative estrogen and progesterone levels were all slightly above the upper limits of normal for females. These hormone and AFP levels fell to within the normal range after removal of the tumor. Direct hormone and AFP production of this tumor was confirmed by immunohistochemical techniques and long-term cell cultures in vitro. This is possibly the first report on a Sertoli-Leydig cell tumor in which AFP has been identified in the patient's plasma, in part of the tumor cells and the culture fluid.

Response to acute hCG stimulation and steroidogenic potential of Leydig cell fibroblastic precursors in humans

The process of early testosterone (T) secretion and Leydig cell differentiation in humans was studied to explore the steroidogenic capacity of Leydig cell fibroblastic precursors. Seven cryptorchid boys received hCG prior to orchidopexy. Patients CP, PB, and MR received one injection of 1000 IU; patients JR and GG, three daily injections of 1000 IU, and patients MP and MM, five daily injections of 1000 IU. A testicular biopsy was obtained at the time of operation, 24 hours after the last injection. Serum T (ng/dl) before and after hCG stimulation and testicular T (ng/g) were determined by RIA. A control prepubertal testis (tumoral orchidectomy) was incubated in vitro and showed a time-dependent accumulation of T both in the medium and the testicular tissue. Testosterone released into the medium at 1, 2, and 4 hours was 0.76, 1.43, and 4.03 ng/ml, respectively. Tissue T at 0, 1, 2, and 4 hours was 9, 11, 16, and 24 ng/g, respectively. This indicates synthesis and secretion of T into the medium. Control testes showed abundant fibroblastic precursors with scanty cytoplasm, few organelles, heterochromatic nuclei, and minute nucleoli. No Leydig cells were present. After 1 day of hCG stimulation, numerous fibroblasts were activated, displaying enlarged cytoplasms with increased numbers of organelles, nuclei rich in euchromatin, and bigger nucleoli. No Leydig cells were present. Basal serum testosterone was 58.2 +/- 45.3 ng/dl and 87.3 +/- 42.0 after hCG administration, while testicular T was 974.0 +/- 686.0 ng/g (control prepubertal testicular T is 10-50 ng/g). After 3 days of hCG, activated fibroblasts increased and immature Leydig cells appeared. Basal serum T was 35.5 +/- 7.8 ng/dl and 394.0 +/- 24.0 after hCG stimulation, while testicular T rose to 2797.5 +/- 1222.6 ng/g. After 5 days, mature Leydig cells appeared for the first time. Serum T was 58 +/- 59.3 ng/dl (basal) and 641.5 +/- 390 ng/dl (after hCG); testicular T was 789 ng/g (patient MM did not have a value for testicular T). HCG induced numerous coated pits and endocytic vesicles in activated fibroblasts and young Leydig cells, suggesting receptor aggregation and internalization of hormone-receptor complexes. Peroxidase-antiperoxidase (PAP) localization of T was positive in peritubular fibroblasts and Leydig cells.(ABSTRACT TRUNCATED AT 400 WORDS)

Sex cord-stromal tumours of the ovary

The aim of this review is to give a reasonably concise resumé of our knowledge of the sex cord-stromal tumours of the ovary. Lipoid cell tumours of the ovary are often included within this broad category but this poorly defined and heterogenous group of neoplasms will not be considered here. This review is a selective one and no attempt is made to cover all aspects of sex cord-stromal tumours or to provide a complete bibliography. The histological features of many of the neoplasms in this group, particularly those which have been recently defined, are discussed but a consideration of differential histological diagnosis is excluded. The ultrastructural characteristics of the various neoplasms are considered only in terms of their relevance to histogenesis or metabolic activity.

Endocrine studies on ovarian androblastomas (Sertoli-Leydig tumors)

Endocrine studies were made on 4 women with ovarian Sertoli-Leydig cell tumors of varying degrees of differentiation. Clinically, all 4 patients showed evidence of increased androgen production, manifested by either hirsutism or virilization. The calculated ratios of steroid hormones between the affected ovarian venous values and peripheral values for testosterone (T), androstenedione (A), and dehydroepiandrosterone (DHEA) in 3 patients, were 1.4-18.6, 4.2-24.4, and 3.7-10.0, respectively. The peripheral levels of the hormones before salpingo-oophorectomy in all the patients were T: 0.97-45.0 ng/ml; A: 2.92-114.0 ng/ml; and DHEA: 13.0-20.9 ng/ml. In the 3 juvenile patients, elevated basal levels of LH and normal or subnormal levels of FSH (high LH:FSH ratio) were found. In a 12-year-old patient with 1,900 g tumor composed predominantly of Sertoli cells with lipid storage, the peripheral serum levels of T and estradiol (E2) were 114 ng/ml and 1890 pg/ml, respectively. The present data suggest that: 1) androblastomas have a biosynthetic capacity for androgen, estrogen, or both in which both the delta 5 and delta 4 pathways are involved, and 2) little correlation exists between the endocrine function and cellular composition of the tumors or their degree of differentiation.

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.

Ligandin in the human ovary

Human ovaries from different times during the menstrual cycle, pregnancy and the post-menopausal state were examined by immunohistochemistry using an antibody to ligandin. The results showed that antiligandin was localized to those cells producing steroids and probably acts as an intracellular transport protein but may also have an enzyme function in steroidogenesis. In demonstrating this relationship this study has indicated that antiligandin may be of value in the morphologic investigation of ovaries in conditions where there are assumed alterations in steroid production.

Large-cell calcifying sertoli cell tumor of the testis. An ultrastructural, immunocytochemical, and biochemical study

This report describes the ultrastructural and hormonal characteristics of the recently described large-cell calcifying Sertoli cell tumor of the testis, a rare subtype of pure Sertoli cell tumor. The ultrastructural findings showed similarity to normal Sertoli cells, pure Sertoli cell tumors, Sertoli cells in azoospermic human testes, and the Sertoli cell component of Sertoli-Leydig cell tumors. Ultrastructure indicated features common to steroid-producing cells. Testosterone and estradiol were demonstrated in the tumor by immunocytochemical and biochemical methods.

Ovarian endometrioid tumors mimicking Sertoli and Sertoli-Leydig cell tumors: Sertoliform variant of endometrioid carcinoma

We have encountered four cases of an unusual variant of well-differentiated endometrioid carcinoma that was predominantly composed of tubules, solid or hollow, as well as cord-like areas histologically mimicking Sertoli and Sertoli-Leydig cell tumors. The two features most helpful in differential diagnosis were the presence of areas of tumor with the typical confluent pattern of endometrioid carcinoma, and the presence of mucin at the apical borders of the tumor cells and/or within glandular lumina. Other features that were helpful if present, but were observed only in one case each, were foci of squamous metaplasia or the presence of ciliated epithelium. In two cases, ultrastructural studies showed well developed microvilli and perinuclear microfilaments confirming the endometrioid nature of the neoplasm. The patients varied from 22-74 years in age. All tumors were confined to a single ovary, and no tumor is known to have recurred or metastasized. One of the patients died at age 80, six years following operation, presumably without evidence of recurrent neoplasm or metastases. Two other patients are living and well, one and 14 years after diagnosis. In one patient follow-up is short. The clinicopathologic features of this variant of endometrioid carcinoma are reviewed with emphasis on differential morphologic features.

Detection of estrogen receptor in breast and endometrial carcinoma by the immunoperoxidase technique

Paraffin-embedded tissues from 15 women with breast or endometrial carcinomas were analyzed in a study designed to explore the possible value and validity of an immunoperoxidase method for the detection of estrogen receptor in formalin-fixed paraffin-embedded tissue. Results were compared with biochemical assays for estrogen receptor performed on cytosols of fresh tissue from the same patients. There was complete correlation in nine of 15 (60%) of the tumors analyzed. Four cases (26.7%) were judged positive for estrogen binding sites by immunoperoxidase but were negative for estrogen receptor by biochemical assays; in two cases the converse was observed. The immunohistologic technique is relatively rapid and utilizes fixed paraffin sections of the same tissue that is used for standard histologic diagnosis. The provision of a permanent record that can be kept for future reference provides an advantage over immunofluorescence methods that have been advanced for the detection of estrogen receptors. The excellent morphology achieved permits an assessment of the staining of individual cells in relation to the usual histologic criteria employed in the diagnosis of breast and endometrial cancer. This stands in contrast to biochemical cytosol-based assays that take no account of variations in receptor expression by the tumor cells or variations in the proportion of the assayed material that is in fact neoplastic as distinct from supporting stroma and connective tissue.

Composite mucinous ovarian neoplasms associated with Sertoli-Leydig and carcinoid tumors

The authors describe two mucinous ovarian tumors that were hormonally active due to Sertoli-Leydig elements within the septal stroma. Carcinoid was also present in each case. The mesenchymal stromal cells within the septa of the mucinous tumors have undergone neoplastic proliferation with the Sertoli and Leydig differentiations, leading to the formation of arrhenoblastoma. The carcinoid component of these tumors is thought to have originated from argentaffin cells of the "intestinal" mucinous epithelium.

Ovarian Sertoli-Leydig cell tumor with hyperoestrinism

This report concerns a very rare case of ovarian Sertoli-Leydig cell tumor associated with an evident hyperoestrinism, that occurred in a 67-year-old woman. The clinical and pathological data are presented and discussed.

Androblastoma: pre-, per- and post-operative steroid hormone and binding protein concentrations in peripheral plasma, cyst fluid and tumor vein

A case-report of arrhenoblastoma is presented where the endocrine profile has been determined before, during and after removal of the tumor. Sex steroids, cortisol, corticosteroid binding globulin (CBG) and sex steroid binding protein (SBP) were measured in fluid from 2 cysts, tumor vein and peripheral plasma. Hormones were measures by specific RIAs after stepwise chromatography on celite support according to a new elution pattern allowing the resolution of 8 sex steroid in a single chromatographic system. Excessive amounts of androgen, the most prominent being testosterone, and 17-OH-progesterone, but low levels of estrogens and progesterone were found in preoperative plasma. Due to an androgen-directed rise of CBG, large amounts of plasma cortisol were detected. However, preoperative SBP capacity was found to be reduced. The steroid profile of cyst fluids was found to be similar to that of peripheral plasma. Neoplastic cells were found capable of producing an androgen binding protein. These results correlated well with Sertoli-Leydig cell tumors histology, i.e. a testis-like endocrine structure. From the endocrine profile, the steroid biosynthetic pathways are discussed with respect to the possibility that biosynthesis, once the 17-OH-pregnenolone structure was reached, was active along both the delta 5 and delta 4-steroid pathways. The steroid levels in tumor vein and their corresponding gradients to the periphery are discussed with respect to: i) the possibility of metabolic and biosynthetic capacities of cancer cells bearing an undifferentiated steroidogenic appearance, ii) the possibility for tumor steroid secretion by others means than by venous blood and iii) the possibility that both point i) and ii) could be the cause of inconsistent diagnosis significant of endocrine profile as observed in some patients.

Extratesticular gonadal stomal tumor in the pelvis. A case report with immunoperoxidase findings

A 40-year-old man with two normally descended testicles and no signs of hormonal anomalies developed a fist-sized extraperitoneal tumor to the left of the urinary bladder. Histologic diagnosis was that of a probably malignant gonadal stromal tumor because of considerable mitotic activity and widespread vascular invasion. Retroperitoneal lymphadenectomy showed no metastatic disease, and the patient is well two years after surgery. By use of an immunoperoxidase method we could demonstrate estradiol and testosterone in the tumor cells. The findings in this case are unique in regard to the extratesticular location of the tumor and support the current view that gonadal stromal tumors arise from a primitive cell with a multidirectional potential for differentiation.

Testicular biopsy in the study of male infertility: its current usefulness, histologic techniques, and prospects for the future

Testicular biopsy has been widely used for the diagnosis of male infertility for more than three decades. During that time, with advances in cytogenetics, radioimmunoassay, and endocrinology, the role of testicular biopsy has changed. Testicular biopsy is still useful in the diagnosis of azoospermic and oligospermic males without stigmata of gonadotropic insufficiency or Klinefelter's syndrome. A classification and description is presented of pathologic changes in the testis as seen on testicular biopsy by light microscopy. The present rationale for testicular biopsy in infertility, the processing and staining of histologic material, and the role of testicular biopsy in infertility and infertility related situations, including cryptorchidism, malignant disease, and chemotherapy related changes, are discussed. Further understanding of testicular function and disease will depend upon the correlation of histologic and ultramicroscopic changes, immunohistologic localization of hormones, and epidemiologic and endocrinologic data.