Rare case of ovarian Sertoli-Leydig cell tumor in an adolescent: a case report

Androgen-producing tumors are rare in females, typically arising from the ovaries or adrenal glands. Sertoli-Leydig cell tumors (SLCTs) are uncommon sex cord-stromal ovarian tumors that cause hyperandrogenism, leading to virilization symptoms such as hirsutism, deep voice, and amenorrhea. Their rarity and similarity with other androgen-secreting conditions make diagnosis challenging. This case report describes an SLCT in a 16-year-old girl, underscoring the value of early diagnosis and fertility-sparing surgery.

A 16-year-old girl presented with secondary amenorrhea, hirsutism, and voice deepening. Hormonal workup revealed elevated testosterone and low sex hormone-binding globulin. Imaging identified a solid mass in the left ovary. Adrenal causes were excluded via hormonal assays and imaging. The patient underwent a laparotomy with left salpingo-oophorectomy. Histopathology confirmed a moderately differentiated SLCT, and immunohistochemistry was positive for inhibin and calretinin. Postoperative CT showed no metastasis. She required no chemotherapy and remained under regular follow-up.

SLCTs represent less than 1% of ovarian tumors and primarily affect young women. They often present with signs of androgen excess. Diagnosis relies on clinical, hormonal, imaging, and histological data. DICER1 gene mutations are frequently associated. Surgical excision is the standard treatment, with fertility-sparing options preferred in early stages. Chemotherapy is reserved for advanced or poorly differentiated cases.

SLCT is a rare but treatable ovarian tumor. Early detection of androgen excess is crucial. Surgery is effective, and fertility can be preserved. Larger registries are needed to enhance disease understanding and management strategies.