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Shrestha S, Homagain S, Bhatta S, Tiwari SB, Rijal R, Aryal R, Sharma N, Paudyal P, Katuwal N, Rawal SJ. Pure Sertoli cell tumor of the ovary: A case report. Clin Case Rep 2022; 10:e05892. [PMID: 35620254 PMCID: PMC9127247 DOI: 10.1002/ccr3.5892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/25/2022] Open
Abstract
Pure Sertoli cell tumors are an uncommon variant of rare ovarian Sertoli‐Leydig cell tumors. Due to nonspecific clinical and imaging features, diagnosis is often made after histopathological examination. The prognosis is excellent as most are detected in the early stages and surgical resection is often curative in most cases.
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Affiliation(s)
- Suraj Shrestha
- Maharajgunj Medical Campus Institute of Medicine Maharajgunj Nepal
| | - Sushan Homagain
- Maharajgunj Medical Campus Institute of Medicine Maharajgunj Nepal
| | - Suraj Bhatta
- Maharajgunj Medical Campus Institute of Medicine Maharajgunj Nepal
| | - Sansar Babu Tiwari
- Department of Pathology Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Rishikesh Rijal
- Maharajgunj Medical Campus Institute of Medicine Maharajgunj Nepal
| | - Roshan Aryal
- Maharajgunj Medical Campus Institute of Medicine Maharajgunj Nepal
| | - Nisha Sharma
- Department of Pathology Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Pooja Paudyal
- Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Neeta Katuwal
- Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital Maharajgunj Nepal
| | - Suniti Joshi Rawal
- Department of Obstetrics and Gynecology Tribhuvan University Teaching Hospital Maharajgunj Nepal
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Clinicopathological Features and Optimal Management of Sertoli–Leydig Cell Tumours of Ovary: A Retrospective Observational Study of Six Cases. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-019-0352-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Inam ZS, Azizi AH, Holland SW. An 88-year-old woman with flushing, alopecia and hirsutism and a Sertoli-Leydig cell tumour. BMJ Case Rep 2018; 2018:bcr-2017-222589. [PMID: 29496685 DOI: 10.1136/bcr-2017-222589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Sertoli-Leydig cell tumour (SLCT) is a rare, androgen-secreting sex cord-stromal tumour of the ovary that usually occurs in young premenopausal women. The major clinical manifestations are virilisation and defeminisation. The following case describes an 88-year-old G1P1 woman, 40 years after menopause, who presented with flushing, hirsutism, voice changes and alopecia along with significantly elevated levels of testosterone. Postoperative report revealed a well-differentiated SLCT in the left ovary. This case is unique in that SLCT is a very rare cancer and even more so in an 88-year-old woman. Taking this case into consideration, it becomes reasonable to check androgen and oestrogen levels in postmenopausal women, not only in patients with signs of virilisation, but also in those with non-classical presentations, such as flushing or heat spells.
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Affiliation(s)
- Zaina S Inam
- Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA
| | | | - Soemiwati W Holland
- Department of Endocrinology, Susquehanna Health System, Williamsport, Pennsylvania, USA
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Horta M, Cunha TM. Sex cord-stromal tumors of the ovary: a comprehensive review and update for radiologists. Diagn Interv Radiol 2016; 21:277-86. [PMID: 26054417 DOI: 10.5152/dir.2015.34414] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Ovarian sex cord-stromal tumors are infrequent and represent approximately 7% of all primary ovarian tumors. This histopathologic ovarian tumor group differs considerably from the more prevalent epithelial ovarian tumors. Although sex cord-stromal tumors present in a broad age group, the majority tend to present as a low-grade disease that usually follows a nonaggressive clinical course in younger patients. Furthermore, because the constituent cells of these tumors are engaged in ovarian steroid hormone production (e.g., androgens, estrogens, and corticoids), sex cord-stromal tumors are commonly associated with various hormone-mediated syndromes and exhibit a wide spectrum of clinical features ranging from hyperandrogenic virilizing states to hyperestrogenic manifestations. The World Health Organization sex cord-stromal tumor classification has recently been revised, and currently these tumors have been regrouped into the following clinicopathologic entities: pure stromal tumors, pure sex cord tumors, and mixed sex cord-stromal tumors. Moreover, some entities considered in the former classification (e.g., stromal luteoma, stromal tumor with minor sex cord elements, and gynandroblastoma) are no longer considered separate tumors in the current classification. Herein, we discuss and revise the ultrasonography, computed tomography, and magnetic resonance imaging characteristics of the different histopathologic types and clinicopathologic features of sex cord-stromal tumors to allow radiologists to narrow the differential diagnosis when facing ovarian tumors.
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Affiliation(s)
- Mariana Horta
- Department of Radiology, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal; Institute of Anatomy, Faculdade de Medicina da Universidade de Lisboa, Portugal.
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Horta M, Cunha TM, Marques RC, Félix A. Ovarian Sertoli-Leydig cell tumor with heterologous elements of gastrointestinal type associated with elevated serum alpha-fetoprotein level: an unusual case and literature review. J Radiol Case Rep 2015; 8:30-41. [PMID: 25926909 DOI: 10.3941/jrcr.v8i11.2272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Here we describe the case of a 19-year-old woman with a poorly differentiated ovarian Sertoli-Leydig cell tumor and an elevated serum alpha-fetoprotein level. The patient presented with diffuse abdominal pain and bloating. Physical examination, ultrasound, and magnetic resonance imaging revealed a right ovarian tumor that was histopathologically diagnosed as a poorly differentiated Sertoli-Leydig cell tumor with heterologous elements. Her alpha-fetoprotein serum level was undetectable after tumor resection. Sertoli-Leydig cell tumors are rare sex cord-stromal tumors that account for 0.5% of all ovarian neoplasms. Sertoli-Leydig cell tumors tend to be unilateral and occur in women under 30 years of age. Although they are the most common virilizing tumor of the ovary, about 60% are endocrine-inactive tumors. Elevated serum levels of alpha-fetoprotein are rarely associated with Sertoli-Leydig cell tumors, with only approximately 30 such cases previously reported in the literature. The differential diagnosis should include common alpha-fetoprotein-producing ovarian entities such as germ cell tumors, as well as other non-germ cell tumors that have been rarely reported to produce this tumor marker.
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Affiliation(s)
- Mariana Horta
- Serviço de Radiologia, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
| | - Teresa Margarida Cunha
- Serviço de Radiologia, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Rita Canas Marques
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Ana Félix
- Serviço de Anatomia Patológica, Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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Sertoli-Leydig tumor and male pseudohermaphroditism discovered during inguinal hernia surgery. Open Med (Wars) 2014. [DOI: 10.2478/s11536-013-0317-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
AbstractThe diagnosis of inguinal hernia is usually clinical and it is performed with high sensitivity and specificity. Very occasionally, it may be confused with other diseases (lymphadenopathy, testicular pathology,etc). We report a rare case of a 80-year-old woman with a clinical diagnosis of hernia, which was underwent surgery and a tumor from the hernia orifice was found. After histological analysis we discovered that the misdiagnosed hernia was actually a tumor on a rudimentary testis. After radiological, gynecological and cytogenetic assessment we obtained an unexpected diagnosis: Male psheudohermaphroditism and Sertoli-Leydigtumor (SLCT) development on the testis. Diagnostic guidance for disorders of sexual development is based almost entirely on pediatric experience and very few guidelines are available for adults. Male pseudohermaphroditism is an intersex condition in which the carriers show a phenotype that includes external female genitalia, but a male genetic and gonadal sex. SLCT are sex-cord stromal tumors which develop in ovary and very rarely in the testis, representing 0.1–0.5% of ovarian tumors and less than 0.2% of testicular tumors. Thus far 24 case have been reported in the literature in which SLCT tumor has developed on testis.
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Cai SQ, Zhao SH, Qiang JW, Zhang GF, Wang XZ, Wang L. Ovarian Sertoli-Leydig cell tumors: MRI findings and pathological correlation. J Ovarian Res 2013; 6:73. [PMID: 24160866 PMCID: PMC3819159 DOI: 10.1186/1757-2215-6-73] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Accepted: 10/21/2013] [Indexed: 11/25/2022] Open
Abstract
Background To investigate the magnetic resonance imaging (MRI) characteristics of ovarian Sertoli-Leydig cell tumors (SLCT). Methods The clinical, MRI and pathological findings of five cases of SLCT were reviewed retrospectively. MRI appearances of tumors including laterality, shape and size, architecture, wall, septa and vegetation, signal intensity and contrast-enhancement pattern were evaluated and correlated with pathological findings. Results Two tumors were solid which appeared as low signal intensity on T1-weighted imaging (T1WI) and moderate on T2-weighted imaging (T2WI) with multiple small cysts in one of them. The remaining three SLCT were multilocular cystic with the irregularly thickened wall and septa, and with solid area and mural nodules in one of them. The cystic components had the same signal intensity as urine. All the solid components were intensely enhanced after administration of contrast medium. All five tumors were pathologically intermediate differentiation and at FIGO stage I. Conclusions SLCT demonstrate variable MRI morphological appearances. However, the irregularly thickened wall and septa, the moderate T2WI signal intensity and obvious enhancement in the solid components are three MRI features.
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Affiliation(s)
| | | | - Jin-Wei Qiang
- Department of Radiology, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai 201508, China.
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Guo L, Yang X, Zhu H, Qiu W, Shi X, Huang B, Duan T. Sertoli–Leydig cell tumor presenting hyperestrogenism in a postmenopausal woman: A case report and review of the literature. Taiwan J Obstet Gynecol 2012; 51:620-4. [DOI: 10.1016/j.tjog.2012.09.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2011] [Indexed: 11/24/2022] Open
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A clinicopathological analysis of 40 cases of ovarian Sertoli–Leydig cell tumors. Gynecol Oncol 2012; 127:384-9. [DOI: 10.1016/j.ygyno.2012.07.114] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2012] [Revised: 07/23/2012] [Accepted: 07/23/2012] [Indexed: 11/19/2022]
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Bhat RA, Lim YK, Chia YN, Yam KL. Sertoli-Leydig cell tumor of the ovary: Analysis of a single institution database. J Obstet Gynaecol Res 2012; 39:305-10. [DOI: 10.1111/j.1447-0756.2012.01928.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vollaard ES, van Beek AP, Verburg FAJ, Roos A, Land JA. Gonadotropin-releasing hormone agonist treatment in postmenopausal women with hyperandrogenism of ovarian origin. J Clin Endocrinol Metab 2011; 96:1197-201. [PMID: 21307133 DOI: 10.1210/jc.2010-1991] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT The most frequent cause of virilization in postmenopausal women is excessive androgen production of ovarian origin. Bilateral oophorectomy is usually performed, even in cases of benign tumors or hyperthecosis. This is the first report of a case series of long-term GnRH-agonist treatment of hyperandrogenism in postmenopausal women. OBJECTIVE We present three women with postmenopausal hyperandrogenism of ovarian origin who were treated with GnRH agonists. PATIENTS We describe three cases of postmenopausal women with virilization and hyperandrogenism of presumed ovarian origin, all with slight enlargement of the ovaries but without visualization of a tumor, who had long-term treatment with GnRH agonists. No histological diagnosis was available, and therefore all patients received careful follow-up, including periodic testing of androgen levels and ovarian imaging by computed tomography scans. The three patients responded in different ways to treatment with GnRH agonists. CONCLUSIONS Long-term GnRH agonist treatment is an acceptable choice for treatment of postmenopausal hyperandrogenism in patients where ovarian origin of androgen excess is ascertained, and especially in those patients who have an increased risk for surgery due to comorbidities or who are unwilling to undergo bilateral oophorectomy.
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Affiliation(s)
- Esther S Vollaard
- Department of Obstetrics and Gynecology, University Medical Center Groningen, University of Groningen, 9700 RB Groningen, The Netherlands.
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Yetkin DO, Demirsoy ET, Kadioglu P. Pure leydig cell tumour of the ovary in a post-menopausal patient with severe hyperandrogenism and erythrocytosis. Gynecol Endocrinol 2011; 27:237-40. [PMID: 20518640 DOI: 10.3109/09513590.2010.490611] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 60-year-old woman, presented with hirsutism, male pattern baldness, deepening voice and plethora over the past 5 years. Hormonal evaluation showed markedly elevated serum testosterone level (> 1600 ng/dl) and oestradiol level (220 pg/ml) normal DHEA-SO4 level with suppressed LH and FSH levels. She had markedly erythrocytosis with normal hematological indices. The diagnosis of probable secondary erythrocytosis was made. Trans abdominal ultrasound and CT scan revealed a 14 cm × 11 cm × 9 cm solid pelvic mass. An ovarian androgen secreting tumour was suspected and surgery was performed. Histological examination showed a leydig cell tumour. After the operation testosterone and haematocrit levels returned to normal with regression of clinical symptoms. This is the first case of a leydig cell tumour with an erythropoietic effect of excess testosterone.
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Affiliation(s)
- Demet Ozgil Yetkin
- Cerrahpasa Medical Faculty, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Istanbul, Turkey.
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Lenhard M, Kuemper C, Ditsch N, Diebold J, Stieber P, Friese K, Burges A. Use of novel serum markers in clinical follow-up of Sertoli-Leydig cell tumours. Clin Chem Lab Med 2007; 45:657-61. [PMID: 17484630 DOI: 10.1515/cclm.2007.120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Miriam Lenhard
- Department of Obstetrics and Gynaecology, Campus Grosshadern, Ludwig-Maximilians-University, Munich, Germany.
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