SERTOLI-LEYDIG CELL TUMOR OF THE OVARY AS AN INCIDENTAL FINDING IN A PATIENT UNDERGOING HYSTERECTOMY DUE TO RECURRENT ABNORMAL UTERINE BLEEDING
Keywords:
Keywords: Sertoli-Leydig cell tumor, retiform histoarchitectonics, endometrial hyperplasia, postmenopausal patientAbstract
Sertoli-Leydig cell tumor (SLCT) of the ovary is a rare neoplasm that accounts for only 0.5% of all primary ovarian neoplasms. Clinical and histopathological presentations of the tumor are different, which makes diagnosis and treatment difficult. We present a case of a 67-year-old female patient, who presented at the University Clinic for Gynecology and Obstetrics with abnormal uterine bleeding. Explorative curettage was performed for the second time after 1 year, with a histopathological finding of endometrial hyperplasia. The patient underwent an excision of a lung tumor 2 years ago, with a histopathological finding of synovial sarcoma of the lungs, after which she received adjuvant chemotherapy. On transvaginal ultrasonography, the patient had no suspicious pathological findings on the uterus and ovaries. Laboratory tests of tumor markers did not show any elevation. Due to recurrent abnormal bleeding from the uterus, the patient underwent an abdominal hysterectomy with bilateral adnexectomy. Histopathology: Sertoli-Leydig tumor of the right ovary with retiform histoarchitectonics, stage IA and atypical endometrial hyperplasia.
Sertoli-Leydig cell tumors have a relatively good prognosis, but their management, surgical treatment and postoperative follow-up due to their rarity is a challenge even today.
References
Varras M, Vasilakaki T, Skafida E, Akrivis C. Clinical, ultrasonographic, computed tomography and histopathological manifestations of ovarian steroid cell tumor, not otherwise specified: our experience of a rare case with female virilization and review of the literature. Gynecol Endocrinol 2011; 27(6): 412-416. doi: 10.3109/09513590.2010.495432.
Busquets M, Gonzalez-Bosquet E, Muchart J, Rovira C, Laïlla JM. Granulosa cell tumor and endometrial cancer: a case report and review of the literature. Eur J Gynaecol Oncol 2010; 31(5): 575-578. PMID: 21061806.
Quirk JT, Natarajan N. Ovarian cancer incidence in the United States, 1992-1999. Gynecol Oncol 2005; 97(2): 519-523. doi: 10.1016/j.ygyno.2005.02.007.
Boyce EA, Costaggini I, Vitonis A, Feltmate C, Muto M, Berkowitz R, et al. The epidemiology of ovarian granulosa cell tumors: a case-control study. Gynecol Oncol 2009; 115(2): 221-225. doi: 10.1016/j.ygyno.2009.06.040.
Berek JS, Hacker NF. Berek & Hacker's Gynecologic Oncology, 6th edition, Wolters Kluwer, Philadelphia 2015.
Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol 2003; 21(6): 1180-1189. doi: 10.1200/JCO.2003.10.019.
Zanagnolo V, Pasinetti B, Sartori E. Clinical review of 63 cases of sex cord stromal tumors. Eur J Gynaecol Oncol 2004; 25(4): 431-438. PMID: 15285297.
Brown J, Sood AK, Deavers MT, Milojevic L, Gershenson DM. Patterns of metastasis in sex cord-stromal tumors of the ovary: can routine staging lymphadenectomy be omitted? Gynecol Oncol 2009; 113(1): 86-90. doi: 10.1016/j.ygyno.2008.12.007.
Miller BE, Barron BA, Wan JY, Delmore JE, Silva EG, Gershenson DM. Prognostic factors in adult granulosa cell tumor of the ovary. Cancer 1997; 79(10): 1951-1955. doi: 10.1002/(sici)1097-0142(19970515)79:10<1951::aid-cncr16>3.0.co;2-u.
Young RH, Scully RE. Ovarian Sertoli-Leydig cell tumors. A clinicopathological analysis of 207 cases. Am J Surg Pathol 1985; 9(8): 543-569. doi: 10.1097/00000478-198508000-00001.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology. Head and neck cancer. Version 1.2021. Available at: https://www.nccn.org/ professionals/physician_gls/https://www.nccn.org/professionals/physician_gls/
Salani R, Backes FJ, Fung MF, Holschneider CH, Parker LP, Bristow RE, et al. Posttreatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncologists recommendations. Am J Obstet Gynecol 2011; 204(6): 466-478. doi: 10.1016/j.ajog.2011.03.008.
Färkkilä A, Koskela S, Bryk S, Alfthan H, Bützow R, Leminen A, et al. The clinical utility of serum anti-Müllerian hormone in the follow-up of ovarian adult-type granulosa cell tumors--A comparative study with inhibin B. Int J Cancer 2015; 137(7): 1661-1671. doi: 10.1002/ijc.29532.
Homesley HD, Bundy BN, Hurteau JA, Roth LM. Bleomycin, etoposide, and cisplatin combination therapy of ovarian granulosa cell tumors and other stromal malignancies: A Gynecologic Oncology Group study. Gynecol Oncol 1999; 72(2): 131-137. doi: 10.1006/gyno.1998.5304.
Gershenson DM, Morris M, Burke TW, Levenback C, Matthews CM, Wharton JT. Treatment of poor-prognosis sex cord-stromal tumors of the ovary with the combination of bleomycin, etoposide, and cisplatin. Obstet Gynecol 1996; 87(4): 527-531. doi: 10.1016/0029-7844(95)00491-2.
Brown J, Shvartsman HS, Deavers MT, Burke TW, Munsell MF, Gershenson DM. The activity of taxanes in the treatment of sex cord-stromal ovarian tumors. J Clin Oncol 2004; 22(17): 3517-3523. doi: 10.1200/JCO.2004.12.074.
Sigismondi C, Gadducci A, Lorusso D, Candiani M, Breda E, Raspagliesi F, et al. Ovarian Sertoli-Leydig cell tumors. a retrospective MITO study. Gynecol Oncol 2012; 125(3): 673-676. doi: 10.1016/j.ygyno.2012.03.024.
Gui T, Cao D, Shen K, Yang J, Zhang Y, Yu Q, et al. A clinicopathological analysis of 40 cases of ovarian Sertoli-Leydig cell tumors. Gynecol Oncol 2012; 127(2): 384-389. doi: 10.1016/j.ygyno.2012.07.114.
