Abstract
BackgroundSertoli-Leydig cell tumor (SLCT) is a rare sex-cord tumor that usually occurs unilaterally and accounts for < 0.5% of all ovarian tumors. SLCT is uncommon in post-menopausal women, with the average age of diagnosis being 25 years.CaseWe present a case of a 63-year-old post-menopausal woman presenting with progressive hirsutism, and male-pattern baldness. Unusual nail changes were also observed.MethodsHormonal profile of the patient revealed increased testosterone and estradiol levels, and a 3.5 cm left ovarian mass. The patient was evaluated and was not found to be anemic or iron-deficient. Intraoperative frozen section assessment during laparoscopic exploration revealed SLCT, which was confirmed subsequently by histopathological and immunohistochemical (IHC) examination. Nail bed tissues were collected from normal females and evaluated by IHC for the presence of androgen receptors (AR).ResultsThe patient had an excellent postoperative course and all her testosterone-related manifestations were reversed within one year of surgery. Following surgery, the patient’s unique nail abnormalities also resolved gradually. The IHC evaluation also confirmed the presence of AR in nail bed tissues of females.ConclusionSLCT, albeit rare, should be considered in post-menopausal women presenting with virilization and elevated androgen levels. Unusual nail signs may develop in response to increased androgen levels in these patients.
Highlights
Sertoli-Leydig cell tumor (SLCT) is a rare sex-cord tumor that usually occurs unilaterally and accounts for < 0.5% of all ovarian tumors
SLCT, albeit rare, should be considered in post-menopausal women presenting with virilization and elevated androgen levels
Following our novel observation of nail changes with the hyperandrogenemia in a post menopausal SLCT patient, we evaluated the presence of androgen receptors (AR) in the nail bed of normal healthy women
Summary
Sertoli-Leydig cell tumor (SLCT) is a rare sex-cord tumor that usually occurs unilaterally and accounts for < 0.5% of all ovarian tumors. Case: We present a case of a 63-year-old post-menopausal woman presenting with progressive hirsutism, and male-pattern baldness. Sertoli-Leydig cell tumor (SLCT) is a rare sex cordstromal tumor that accounts for less than 0.5% of all ovarian neoplasms [1]. In contrast to other types ovarian tumors (epithelial or germ-cell), SLCTs may present with clinical signs and symptoms related to excess androgen production such as virilization [4]. Such manifestations include: progressive hirsutism, deepening of voice, male pattern scalp hair recession, increased musculature, and clitoromegaly. Patients can present with estrogenic manifestations [5]
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