Sertoli-Leydig cell tumor: An unusual pathological presentation raising a therapeutic dilemma, a case report

Sertoli-Leydig cell tumors (SLCTs) are rare, with a challenging diagnosis and management. Herein is our case.

We report the case of a 14-year-old female patient who presented with secondary amenorrhea with clinical signs of virilization. A pelvic MRI showed a solid-cystic intraperitoneal mass. The patient underwent surgery. A left adnexectomy, along with an omentectomy, peritoneal biopsy, and peritoneal cytology sampling, was performed. The histopathological examination confirmed a Sertoli-Leydig cell tumor of the left ovary. While the majority of the tumor cells were well-differentiated, a focal area contained poorly differentiated cells with high mitotic activity and sarcoma-like features. The case was presented at a multidisciplinary tumor board meeting to assess the potential benefit of adjuvant chemotherapy, given the presence of a poorly differentiated component. However, adjuvant chemotherapy was not recommended.

SLCTs are rare ovarian neoplasms that predominantly affect individuals of reproductive age. Virilization occurs in up to 60 % of cases. Serum tumor markers can aid in the detection of SLCTs. According to the latest WHO classification, SLCTs are categorized as well-differentiated, moderately differentiated, or poorly differentiated. Surgical resection remains the gold standard treatment, while postoperative chemotherapy is recommended for patients with poor prognostic factors. However, managing SLCTs remains challenging due to the lack of standardized treatment guidelines. Prognosis is primarily determined by tumor stage and degree of differentiation.

Managing SLCTs remains complex, and further studies are needed to better define treatment guidelines.