Clinical and Ultrasound Features of Ovarian Sertoli-Leydig Cell Tumors: A Case Series and Literature Review

Aimed to characterize the clinical and ultrasound characteristics of ovarian Sertoli-Leydig cell tumors (SLCTs) with standardized terminology.

A retrospective analysis was conducted on individuals diagnosed with ovarian SLCTs at West China Second University Hospital between January 2015 and January 2025, and confirmed by pathology and immunohistochemistry. The International Ovarian Tumor Analysis (IOTA) terminology was employed to systematically describe the sonographic features of ovarian SLCTs. The study compiled the clinical and sonographic characteristics of ovarian SLCTs, drawing from cases at WCSUH-SCU and a literature review performed utilizing PubMed from January 1, 1995, to July 31, 2025.

Seventeen subjects, aged 12-77 (median, 32) years, were encompassed in the cohort. Three subjects had well-differentiated tumors, eight had moderately differentiated tumors, and six had poorly differentiated tumors. Fourteen subjects presented with endocrine symptoms. Eleven subjects with well- or moderately-differentiated SLCTs underwent unilateral salpingo-oophorectomy or ovarian tumor resection. Ultrasound examinations revealed that most lesions were regularly round or ovoid (82.4%), had regular margins (94.1%), had uniform echogenicity (58.8%), and were hypoechogenic (88.2%). Most lesions displayed moderate to abundant vascularity (color score of 3-4, 76.5%). A literature retrieval yielded 14 articles reporting the ultrasonographic features of 44 ovarian SLCT cases with characteristics comparable to those in the present cohort.

The ultrasonographic features of ovarian SLCTs include hypoechoic masses with homogeneous or heterogeneous echogenicity, often containing cystic components within the lesions. Scattered vascular distribution is observed within the tumor, with circumferential vascular patterns in some cases, and these lesions are frequently accompanied by endocrine symptoms.