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Khalloufi C, Joudar I, Kanas A, Benhessou M, Ennachit M, El Kerroumi M. Ovarian Sertoli-Leydig tumor: A tricky tumor case report. Int J Surg Case Rep 2023; 105:108043. [PMID: 36989630 PMCID: PMC10074573 DOI: 10.1016/j.ijscr.2023.108043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Ovarian Sertoli-Leydig cell tumors (SLCT) are a rare sex cord-stromal tumors, accounting for <0,2 % of all ovarian malignancies. As these tumors are found at an early stage in young women, the whole management dilemma is finding the right balance between a treatment efficient enough to prevent recurrences but that still enables fertility-sparing. CASE PRESENTATION We report the case of a 17 years old patient hospitalized in the oncology and gynecology ward of the university hospital Ibn Rochd in Casablanca, presenting a moderately differentiated Sertoli-Leydig cell tumor in the right ovary, our aim is to analyze the clinical, radiological and histological characteristics of this rare tumor that can be tricky to diagnose and review the different management therapies available and the challenges they present. CLINICAL DISCUSSION Ovarian Sertoli-Leydig cell tumors (SLCT) are rare sex cord-stromal tumors that should not be misdiagnosed. The prognosis of patients with grade 1 SLCT is excellent without adjuvant chemotherapy. Intermediate and poorly differentiated SLCTs require a more aggressive management. Complete surgical staging and adjuvant chemotherapy should be considered. CONCLUSION Our case reaffirms that in the presence of a pelvic tumor syndrome and signs of virilization, SLCT should be suspected. The treatment is essentially surgical, if diagnosed early on, we can offer an effective treatment that preserves their fertility. Efforts should be focused on the creation of regional and international registries of SLCT cases in order to achieve greater statistical power in future studies.
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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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Huang LJ, Shi LY, Duan J. Clinicopathological analysis of ovarian sertoli-leydig cell tumor with postmenopausal vaginal bleeding as the first symptom: A case report. Medicine (Baltimore) 2021; 100:e24922. [PMID: 33787579 PMCID: PMC8021331 DOI: 10.1097/md.0000000000024922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 02/04/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONAL Ovarian sertoli-leydig cell tumor (OSLCT) is extremely rare. We reported a OSLCT case in whom postmenopausal vaginal bleeding was the first symptom. PATIENT CONCERNS The patient came to our hospital due to postmenopausal vaginal bleeding. DIAGNOSES Serum tumor markers and color Doppler ultrasound for her pelvic cavity were negative. The patient was finally diagnosed with left OSLCT by pathology. It was difficult to make a definite diagnosis before operation, the diagnosis of OSLCT required postoperative pathology in the patients. INTERVENTIONS the patient underwent laparoscopic hysterectomy+bilateral adnexectomy+lysis of pelvic adhesions. OUTCOMES Postoperative laboratory examinations were normal. The patient was discharged from our hospital on the seventh day after operation and came to our hospital for follow-up check in April 2020. Physical and laboratory examinations were normal. LESSONS OSLCT can show different endocrine abnormalities, which are related to the various types of tumor tissues. Missed diagnosis and misdiagnosis are likely to occur in the patients who only have elevated serum testosterone. For the menopausal women with elevated serum testosterone, ovarian tumor shoule be highly suspected after excluding adrenal gland-related diseases.
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Affiliation(s)
- Li-juan Huang
- Medical School, Wuhan University of Science and Technology
| | - Liang-yan Shi
- Department of Obsterics and Gynecology, Hubei Maternal and Child Health Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China
| | - Jie Duan
- Department of Obsterics and Gynecology, Hubei Maternal and Child Health Hospital Affiliated to Huazhong University of Science and Technology, Wuhan, China
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Eoh KJ, Park J, Kim HM, Lee M, Kim YT. Comparison of the Prognostic Outcome between High-Grade Ovarian Sertoli-Leydig Cell Tumors (SLCTs) and Low-Grade SLCTs. Yonsei Med J 2021; 62:366-369. [PMID: 33779091 PMCID: PMC8007424 DOI: 10.3349/ymj.2021.62.4.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 12/02/2020] [Accepted: 01/05/2021] [Indexed: 11/27/2022] Open
Abstract
The purpose of the current study was to compare prognostic outcomes between patients with high-grade ovarian Sertoli-Leydig cell tumors (SLCTs) and those with other low-grade SLCTs. We retrospectively reviewed medical records for 24 patients pathologically diagnosed with SLCTs between 2006 to 2019 at two institutions. The patients were grouped according to pathological grade: SLCT was classified as grade 1, well differentiated; grade 2, intermediated differentiated; or grade 3, poorly differentiated (Meyer's classification). Statistical analysis was performed to compare survival outcomes according to pathological grade. The median patient age was 42.5 years (range 16-75). Eighteen patients (75%) were International Federation of Gynecology and Obstetrics stage I, and none were diagnosed in stage IV. Nine patients (37.5%) were grade 3, and 15 patients (63.5%) were grades 1-2. When comparing clinical baseline characteristics of the grade 1-2 group with those of the grade 3 group, only serum CA125 level at diagnosis was significantly higher in the grade 3 group (38.34 vs. 382.29, p=0.002). Five patients experienced recurrence of grade 3 disease, while no recurrence was reported in grade 1-2 disease. Four of the five recurrent patients died. In result, grade 3 ovarian SLCT showed significantly poorer prognosis than grade 1-2 disease (overall survival, hazard ratio=14.25, 95% confidence interval=1.881-108.0; log-rank p=0.010). Our findings were consistent with the concept that patients with stage I/grade 1-2 tumors have a good prognosis without adjuvant chemotherapy. Since grade 3 ovarian SLCT appears to be relatively more fatal than grade 1 or 2, patients with grade 3 SLCT might require more aggressive surgical intervention and post-treatment surveillance.
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Affiliation(s)
- Kyung Jin Eoh
- Department of Obstetrics and Gynecology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Junsik Park
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea
| | - Hye Min Kim
- Department of Pathology, Yonsei University College of Medicine, Yongin Severance Hospital, Yongin, Korea
| | - Maria Lee
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, Korea
| | - Young Tae Kim
- Department of Obstetrics and Gynecology, Institute of Women's Medical Life Science, Yonsei University College of Medicine, Severance Hospital, Seoul, Korea.
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Sahoo TK, Kar T, Kar A, Panda S. Poorly Differentiated Sertoli-Leydig Cell Tumour of Ovary with Heterologous Elements. J Clin Diagn Res 2017; 11:XD01-XD02. [PMID: 28658892 DOI: 10.7860/jcdr/2017/25262.9860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Accepted: 03/09/2017] [Indexed: 11/24/2022]
Abstract
Sertoli-Leydig Cell Tumour (SLCT) is included under sex-cord stromal tumour of testis or ovary. Ovarian pathology is an extremely rare entity constituting less than 0.5% of all ovarian neoplasms. Majority of the cases present at younger age group, i.e., 2nd and 3rd decade of life. The clinical presentation depends on either mass effect or excess hormone production. Virillization symptoms are the most common presentation and depend upon the quantity of androgen production. Most of the patients have a unilateral mass without extraovarian spread and present at stage-I. Treatment and prognosis depends on the degree of the differentiation and the stage of the disease. Here, we report a case of SLCT of the ovary in a young female. The patient initially presented with pain abdomen due to mass effect and was treated with conservative surgery followed by adjuvant chemotherapy due to the presence of poorly differentiated pathology with heterologous elements.
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Affiliation(s)
- Tapan Kumar Sahoo
- Senior Resident, Department of Radiation Oncology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Tushar Kar
- Professor, Department of Obstetrics and Gynaecology, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Asaranti Kar
- Associate Professor, Department of Pathology, Sriram Chandra Bhanja Medical College, Cuttack, Odisha, India
| | - Sasmita Panda
- Assistant Professor, Department of Pathology, Acharya Harihara Regional Cancer Centre, Cuttack, Odisha, India
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A novel clinicopathological analysis of early stage ovarian Sertoli-Leydig cell tumors at a single institution. Obstet Gynecol Sci 2017; 60:39-45. [PMID: 28217670 PMCID: PMC5313362 DOI: 10.5468/ogs.2017.60.1.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 08/02/2016] [Accepted: 08/18/2016] [Indexed: 12/18/2022] Open
Abstract
Objective To evaluate the clinical and pathologic characteristics of patients who were diagnosed with ovarian Sertoli-Leydig cell tumors (SLCTs) in a single institution. Methods The medical records of 11 patients who were pathologically diagnosed with SLCTs beginning in 1995 in a single institute was reviewed. Results The median patient age was 31 years (range, 16 to 70 years). Patient International Federation of Gynecology and Obstetrics stages were IA, IC, and IIB in 3 (27.3%), 6 (54.5%), and 2 (18.2%) patients, respectively. Six patients (54.5%) had grade 3 tumors, 3 patients (27.3%) had grade 2 tumors, and 1 patient (9.1%) had a grade 1 tumor. Four patients without children underwent fertility-sparing surgery, and 7 patients had full staging surgery, including a hysterectomy and bilateral salpingo-oophorectomy, with a laparoscopic approach used in 3. Eight patients underwent pelvic lymph node dissection, and 8 patients were administered adjuvant chemotherapy consisting of bleomycin, etoposide, and cisplatin in 6 cases, a modified bleomycin, etoposide, and cisplatin regimen in 1 case, and a combined paclitaxel and cisplatin regimen in 1 case. Two patients died of disease and were re-diagnosed with Sertoli form endometrioid carcinoma. The other patients remain alive without recurrence at the time of reporting. Conclusion Our findings suggest that regardless of tumor stage or grade, ovarian SLCT patients have a good prognosis. Close observation and unilateral salpingo-oophorectomy would be beneficial for women who still wish to have children, while hysterectomy and bilateral salpingo-oophorectomy with adjuvant chemotherapy would be the optimal treatment in other cases. Furthermore, meticulous pathologic diagnosis is needed to develop a precise treatment strategy.
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Stavrakis T, Kalogiannidis I, Petousis S, Tsompanidou C, Delkos D, Prapas N, Rousso D. Fertility-sparing management and obstetric outcomes in a 20-year-old patient with a Sertoli-Leydig cell tumor of the ovary: A case report and review of the literature. Oncol Lett 2016; 12:1079-1082. [PMID: 27446397 PMCID: PMC4950529 DOI: 10.3892/ol.2016.4695] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 11/26/2015] [Indexed: 11/05/2022] Open
Abstract
Sertoli-Leydig cell tumors (SLCTs) are an uncommon subtype of sex-cord stromal tumors of the ovary, which most commonly arise in women of reproductive age, creating an issue with regard to the preservation of fertility. The clinical manifestation of SLCTs varies widely, ranging from an asymptomatic clinical profile to extreme virilization. Correct diagnosis of SLCT is crucial and is primarily based on histopathological results. The current study presents the case of a 20-year-old woman who underwent unilateral salpingo-oophorectomy and adjuvant chemotherapy due to the diagnosis of an SLCT of the left ovary. Almost 2 years after the initial surgery, during the follow-up period, the patient conceived normally. Pregnancy was uneventful and the patient vaginally delivered a healthy infant at 38 weeks of gestation. A total of 1 year after delivery (3 years after the initial diagnosis), follow-up of the patient did not reveal any disease recurrence. In conclusion, SLCTs may be adequately treated by fertility-sparing surgery and chemotherapy in young women who wish to preserve their fertility. Natural conception, an uncomplicated pregnancy and a vaginal delivery are possible.
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Affiliation(s)
- Thomas Stavrakis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Stamatios Petousis
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Chrisoula Tsompanidou
- Department of Pathology, ‘Agios Dimitrios’ General Hospital, 54634 Thessaloniki, Greece
| | - Dimitris Delkos
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - Nikolaos Prapas
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
| | - David Rousso
- Third Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54642 Thessaloniki, Greece
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Tetsi Nomigni M, Ouzounian S, Benoit A, Vadrot J, Tissier F, Renouf S, Lefebvre H, Christin-Maitre S, Louiset E. Steroidogenic enzyme profile in an androgen-secreting adrenocortical oncocytoma associated with hirsustism. Endocr Connect 2015; 4:117-27. [PMID: 26034121 PMCID: PMC4453718 DOI: 10.1530/ec-15-0014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 04/27/2015] [Indexed: 11/08/2022]
Abstract
Hirsutism induced by hyperandrogenism can be associated with polycystic ovary syndrome, 21-hydroxylase (OH) deficiency or androgen-secreting tumors, including ovarian and adrenal tumors. Adrenal androgen-secreting tumors are frequently malignant. Adrenal oncocytomas represent rare causes of hyperandrogenism. The aim of the study was to investigate steroidogenic enzyme expression and steroid secretion in an androgen-secreting adrenal oncocytoma in a young woman presenting with hirsutism. Hyperandrogenism was diagnosed on the basis of elevated plasma Δ4-androstenedione and testosterone levels. Pelvic ultrasound was normal, CT scanning revealed a right adrenal mass. Androgens were assessed in adrenal and ovarian vein samples and proved a right adrenal origin. Adrenalectomy normalized androgen levels and the adrenal tumor was diagnosed as an oncocytoma. Real time-PCR, immunohistochemistry and cell culture studies were performed on tumor explants to investigate the steroid secretion profile. Among enzymes required for cortisol synthesis, 17α-OH and 3β-hydroxysteroid dehydrogenase 2 (3β-HSD2) were highly expressed whereas 21-OH and 11β-OH were weakly produced at the mRNA and/or protein levels. Enzymes involved in testosterone production, 17β-HSD5 and 17β-HSD3, were also detected. ACTH receptor was present in the tissue. Cortisol, Δ4-androstenedione and testosterone secretions by cultured cells were increased by ACTH. These results provide the first demonstration, to our knowledge, of abnormal expression profile of steroidogenic enzymes in an adrenocortical oncocytoma. Our results also indicate that Δ4-androstenedione hypersecretion resulted from high 17α-OH and 3β-HSD2 expression in combination with low expression of 21-OH and 11β-OH. Testosterone production was ascribed to occurrence of 17β-HSD5 and 17β-HSD3. Finally, our results indicate that androgen secretion was stimulated by ACTH.
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Affiliation(s)
- Milène Tetsi Nomigni
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
| | - Sophie Ouzounian
- Department of Endocrinology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Alice Benoit
- Department of Endocrinology, Diabetes and Metabolic Diseases, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Jacqueline Vadrot
- Department of Pathology, Hôpital Sud Francilien, Corbeil-Essonnes, France
| | - Frédérique Tissier
- Department of Pathology, Assistance Publique des Hôpitaux de Paris, Hôpital Pitié Salpétrière Pierre-et-Marie Curie University, Paris, France
| | - Sylvie Renouf
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
| | - Hervé Lefebvre
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
- Department of Endocrinology, Diabetes and Metabolic Diseases, Rouen University Hospital, 76000, Rouen, France
- Correspondence should be addressed to H Lefebvre
| | - Sophie Christin-Maitre
- Department of Endocrinology, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM, U933, Paris, France
| | - Estelle Louiset
- INSERM, U982, Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, Institute for Research and Innovation in Biomedicine, Mont-Saint-Aignan, France
- University of Rouen, Mont-Saint-Aignan, France
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Tyagi R, Agrawal P, Nijhawan R, Prasad G. Bilateral sertoli-leydig cell tumor in a primigravida: a rare case. Rare Tumors 2014; 6:5408. [PMID: 25002956 PMCID: PMC4083676 DOI: 10.4081/rt.2014.5408] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 04/27/2014] [Accepted: 04/27/2014] [Indexed: 11/25/2022] Open
Abstract
We present a unique case of incidentally discovered bilateral Sertoli Leydig cell tumour in a primigravida who displayed no features of virilization. The apha fetoprotein levels were elevated. Magnetic resonance imaging was suggestive of ovarian tumors, possibly germ cell tumor. Bilateral salpingo-oophorectomy was performed and histopathology showed features of Sertoli Leydig cell tumor with intermediate to poor differentiation. Immunohistochemistry was positive for calretinin and inhibin, while cytokeratin was negative. Four courses of bleomycin-, etoposide- and cisplatin-based chemotherapy regimen was started, but the patient aborted while receiving the second cycle of chemotherapy. She received the remaining two cycles of chemotherapy and is now on close follow up with monitoring of serum inhibin levels to detect any tumor recurrence. Bilateral Sertloli Leydig cell tumor has not been reported previously in a pregnant female. The aim of this article is to describe the clinical, radiological and pathological features and management of this rare entity.
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Affiliation(s)
- Ruchita Tyagi
- Departments of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Parimal Agrawal
- Departments of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Raje Nijhawan
- Departments of Cytology and Gynecological Pathology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
| | - Grv Prasad
- Departments of Obstetrics and Gynecology, Post Graduate Institute of Medical Education and Research , Chandigarh, India
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Braun R, Peter A, Warmann S, Fuchs J, Binder G. Fast intraoperative testosterone assay confirms the location of an ovarian virilizing tumor in a young girl. Horm Res Paediatr 2013; 79:110-3. [PMID: 22832040 DOI: 10.1159/000339683] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2012] [Accepted: 05/17/2012] [Indexed: 11/19/2022] Open
Abstract
The detection of testosterone-producing ovarian tumors in childhood and adolescence by imaging techniques only can be difficult because of the tumors' radiological structure and sometimes diminutive size. We describe an 11.5-year-old girl with a 9-month history of voice deepening, mild hirsutism, minor acne, increased growth velocity, weight gain, and clitoromegaly. Laboratory investigation revealed an extremely elevated serum testosterone level without any additional endocrine abnormalities. Abdominal ultrasound and MRI showed a sparsely noticeable solid mass in the center of the right ovary. At laparotomy, blood was selectively drawn from the right and the left ovarian veins. Rapid testosterone measurement revealed a 70-fold higher testosterone concentration in the right ovarian vein within 45 min. Based on this finding, a right salpingo-oophorectomy was performed. The patient's postoperative testosterone level declined within 24 h. The histopathological diagnosis was Leydig cell tumor. In conclusion, the implementation of a fast intraoperative testosterone assay enabled the localization and curative therapy of a Leydig cell tumor. This technique seems to be a good alternative to preoperative selective venous blood sampling when body imaging does not unveil the tumor's site.
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Affiliation(s)
- R Braun
- Pediatric Endocrinology and Diabetology, University Children's Hospital, Tübingen, Germany
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11
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Poorly differentiated ovarian sertoli-leydig cell tumor in a 16-year-old single woman: a case report and literature review. Case Rep Obstet Gynecol 2013; 2013:858501. [PMID: 23878752 PMCID: PMC3708428 DOI: 10.1155/2013/858501] [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: 05/14/2013] [Accepted: 06/18/2013] [Indexed: 11/17/2022] Open
Abstract
Sertoli-Leydig cell tumor (SLCT) of ovary is an exceedingly unusual neoplasm that belongs to a group of sex cord-stromal tumors of ovary and accounts for less than 0.5% of all primary ovarian neoplasms. Very few case reports have been documented in the literature so far. Herein, we report a case of primary poorly differentiated ovarian Sertoli-Leydig cell tumor (SLCT) involving the left ovary in a 16-year-old single woman who presented with a 3-month history of a pelviabdominal mass, acne, hirsutism, and menstrual irregularities. In addition, a literature review on ovarian SLCTs is provided.
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12
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Leydig cell tumors in children: contrasting clinical, hormonal, anatomical, and molecular characteristics in boys and girls. J Pediatr 2012; 161:1147-52. [PMID: 22727875 DOI: 10.1016/j.jpeds.2012.05.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Revised: 04/03/2012] [Accepted: 05/16/2012] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To analyze the clinical, hormonal, anatomical, and molecular characteristics of Leydig cell tumors, a very rare cause of progressive hyperandrogenism in children. STUDY DESIGN Description of a 9-year-old boy with isosexual precocious pseudopuberty, and of a 12-year-old girl with rapidly progressive virilization, both due to a pure Leydig cell tumor. Review of all cases of pediatric Leydig cell tumors published since 1999 (when the first somatic mutations of the luteinizing hormone receptor were described) and reporting hormonal and/or molecular data. RESULTS Boys (n = 24) are younger than girls (n = 12) at diagnosis (median 6.5 vs 13.0 years, P = .04). Plasma gonadotrophins are more often completely suppressed in boys (6 cases) than in girls (2 cases). Pure Leydig cell tumors are exceedingly rare in girls (2 cases), who most often have Sertoli-Leydig tumors. These tumors affect either testis equally (11 left, 13 right) but occur more often in the left ovary (8 left, 3 right). Activating mutations of the alpha-subunit of the G(s) stimulatory protein have not been found in either boys or girls and activating mutations of the luteinizing hormone receptor have only been found in boys. CONCLUSIONS Leydig cell tumors in children display clinical, hormonal, anatomical, and molecular sexual dimorphism.
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Gowri V, Koliyadan SV, Al Hamdani A, Al Kindy N. Successful term pregnancies after laparoscopic excision of poorly differentiated Sertoli-Leydig cell tumor of the ovary. J Gynecol Oncol 2012; 23:201-4. [PMID: 22808364 PMCID: PMC3395017 DOI: 10.3802/jgo.2012.23.3.201] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 01/19/2012] [Accepted: 02/01/2012] [Indexed: 11/30/2022] Open
Abstract
Ovarian Sertoli-Leydig cell tumors are rare sex cord-stromal tumors, accounting for less than 1% of ovarian tumors. Majority of these tumors are benign and unilateral, only 3-5% are bilateral. These patients present with clinical features of virilization due to excessive secretion of testosterone from the tumor, however 50% may have no endocrine symptoms. We report a case of poorly differentiated Sertoli-Leydig cell tumour in a woman diagnosed during routine investigation of infertility. She had two spontaneous successful pregnancies after tumor excision laparoscopically.
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Affiliation(s)
- Vaidyanathan Gowri
- Department of Obstetrics and Gynecology, Sultan Qaboos University Hospital, Sultan Qaboos University College of Medicine, Muscat, Sultanate of Oman
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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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Sigismondi C, Gadducci A, Lorusso D, Candiani M, Breda E, Raspagliesi F, Cormio G, Marinaccio M, Mangili G. Ovarian Sertoli-Leydig cell tumors. A retrospective MITO study. Gynecol Oncol 2012; 125:673-6. [DOI: 10.1016/j.ygyno.2012.03.024] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 03/10/2012] [Accepted: 03/14/2012] [Indexed: 11/15/2022]
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Persechini ML, Motton S, Leguevaque P, Donadille F, Escourrou G, Vierasu B, Hamdi S, Bennet A, Caron P. Virilising ovarian tumour: a case associating a Sertoli-Leydig cell tumour and a Brenner tumour. Gynecol Endocrinol 2011; 27:345-50. [PMID: 20569103 DOI: 10.3109/09513590.2010.492883] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian Sertoli-Leydig cell tumours (SLCT), also termed arrhenoblastomas, are the most frequent virilising tumours in women of reproductive age. Very rare secretory Brenner tumours (BT) have been described, generally after the menopause. A 31-year-old woman sought medical advice for secondary amenorrhoea, progressive hirsutism and a 5-year history of virilisation syndrome with clitoromegaly. Testosterone was markedly high (285 ng/dl, N<85) with moderate elevation of delta 4-androstenedione (D4AD) (311 ng/dl, N <270), dehydroepiandrosterone sulfate (DHEAS) (366 μg/dl, N <340) and 17-hydroxyprogesterone (17OHP) (275 ng/dl). LH was 9 IU/l, FSH 4.3 IU/l, estradiol 60 pg/ml and progesterone 314 ng/100 ml. Cortisol was decreased (1.3 μg/dl) after the dexamethasone suppression test. Pelvic MRI showed a 5-cm right ovarian tumour with a 2.5 cm nodular component and cystic areas, and two nodules measuring 11 mm and 15 mm above the right and left ovaries. After right ovariectomy by laparoscopy, pathological examination concluded on a 3-cm SLCT and a 2-cm BT; the nodules above the ovaries were dysembryoplastic cysts. Postoperatively, testosterone level was normal after 24 h (26 ng/dl), estradiol and progesterone rapidly decreased, cyclic secretion then resumed and the patient menstruated at day 27. To our knowledge, this is the first report of an ovarian tumour associating a Sertoli-Leydig cell tumour and a Brenner tumour in a patient with virilisation syndrome which resolved after ovariectomy.
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Affiliation(s)
- Marie-Laure Persechini
- Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier Universitaire Larrey, Toulouse, France
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Poiana C, Virtej I, Carsote M, Banceanu G, Sajin M, Stanescu B, Ioachim D, Hortopan D, Coculescu M. Virilising Sertoli-Leydig cell tumour associated with thyroid papillary carcinoma: case report and general considerations. Gynecol Endocrinol 2010; 26:617-22. [PMID: 20632913 DOI: 10.3109/09513591003686361] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We present a case of a Sertoli-Leydig cell tumour manifested with progressive hirsutism, frontal alopecia and secondary amenorrhea in a 46-years-old female, evolving for 6 years until presentation. Serum testosterone level was 8.01 ng/ml and gonadotropic hormones were LH 8.57 mIU/ml and FSH 9.52 mIU/ml. Computed tomography revealed a dense, solid, heterogeneous mass of 3.5/2.8 cm in the right ovary. Bilateral ovariectomy and hysterectomy were performed. The histopathological report mentioned a Sertoli-Leydig cell tumor with intermediate grade of differentiation. Immunohistochemical stains showed positive reaction for alpha-inhibin, calretin and for progesterone receptor. The testosterone levels dramatically decreased after surgery (0.31 ng/ml) while levels of gonadotropes increased: LH 40.98 mIU/ml and FSH 50.41 mIU/ml. At 6 months follow-up the diagnosis of a left lobe thyroid nodule leaded to fine needle aspiration biopsy with suspicion of papillary carcinoma. Total thyroidectomy established the diagnosis of thyroid papillary carcinoma (2.17/2.18 cm) T2N0M0, stage II, followed by radioiodine administration. This is to our knowledge the first presented case of ovarian Sertoli-Leydig cell tumour associated with papillary thyroid carcinoma. This could suggest a common genetic background.
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Affiliation(s)
- Catalina Poiana
- Department of Endocrinology, C I Parhon Institute of Endocrinology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania.
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