Well-Differentiated Ovarian Sertoli-Leydig Cell Tumors

Abstract

The authors have analyzed a series of more than 200 Sertoli-Leydig cell tumors to investigate the relation of their histologic features to survival. In this report the results of their study of well-differentiated Sertoli-Leydig cell tumors are presented with a review of their clinical and pathological features. The review of 200 Sertoli-Leydig tumors from the consultation files at Harvard Medical School disclosed 17 that were well differentiated. Six additional cases were obtained from the files of the James Homer Wright Pathology Laboratories of the Massachusetts General Hospital. Twenty-two patients, whose age at the time of operation is known, were 18 to 61 years old (average 34.5 years). Most of the tumors were discovered during the investigation of virilization (five cases), irregular menses (four cases), hirsutism (two cases), primary amenorrhea (one case), secondary amenorrhea of 5 years's duration (one case), menorrhagia (one case, infertility (one case) and postmenopausal bleeding associated with polyps and carcinoma of the endometrium (one case). Adenexal masses were palpable preoperatively in 11 patients. The serum testosterone level was measured in two of the four masculinized patients. The level was elevated in both cases; in one it was 296 ng/100 ml and in the other it was 228 ng/100 ml (normal value 25–90). Urinary 17-ketosteroid levels were recorded in six cases; the level was normal in five and elevated to 24 mg/24 hour (normal value 6–15) in one of them. The tumors were unilateral and measured from 1.5 to 10 cm in greatest diameter with an average of 5.3 cm. All of them had a smooth external surface and were stage lai. Eleven patients were treated by unilateral salpingo-oophorectomy, four by unilateral salpingo-oophorectomy with hysterectomy, five by bilateral salpingo-oophorectomy with hysterectomy, and one by bilateral salpingo-oophorectomy. In one patient, who was thought to have polycystic ovarian disease preoperatively, bilateral wedge resections were performed, followed by a unilateral salpingo-oophorectomy 5 months later. In the final patient the tumor was “shelled-out.” Sectioning of the tumors revealed uniformly solid tissue in 20 cases and solid and cystic components in three cases. The solid tissue was firm and usually lobulated by fibrous bands; it was yellow in 13 cases and yellow-tan or white in the remainder. Microscopic examination revealed a predominance of solid tubules in five, and approximately equal numbers of hollow and solid tubules in three. Lobulation by intersecting bands of fibrous tissue was prominent on low power examination in 14 cases (Fig. 1).