Sertoli-Leydig cell tumors of ovary: A case series

Abstract

Introduction: The purpose of this study was to report the clinical features, computed tomography (CT) and magnetic resonance imaging (MRI) findings, clinical management, and prognoses of 7 patients with Sertoli-Leydig cell tumors (SLCT) of ovary, and to review the literature of this rare condition.

Methods: Seven patients with pathologically confirmed ovarian SLCT were included. Their clinical, CT and MRI characteristics (CT images obtained from 6 patients and MR images from 4 patients), clinical management, and prognoses of 7 patients were retrospectively analyzed.

Results: Patients symptoms included irregular menstruation (n = 3), infertile (n = 1), vaginal bleeding after 7 years of menopause (n = 1), a palpable abdominal mass (n = 1), and abdominal pain (n = 1). Three patients had elevated alpha-fetoprotein (AFP), 1 had elevated cancer antigen 125 (CA125), and 2 had elevated Testosterone (T). The 7 tumors of 7 patients were solid or mixed solid-cystic mass with clear boundaries. The solid components of the tumors showed iso-dense on CT. On MRI, the solid components showed iso- or slightly low signal intensity (SI) on T1-weighted imaging (T1WI), high or slightly high SI on T2WI, and high on diffusion-weighted imaging (DWI) with low apparent diffusion coefficient (ADC) value. On contrast-enhanced CT and MRI, 1 tumor exhibited heterogeneous enhancement consisting of multiple nodules with relatively marked homogeneous enhancement, and other 6 tumors showed moderate or marked and constantly heterogeneous enhancements. All patients were treated with surgical excision. Only 3 had received postoperative chemotherapy. With the exception of 1 patient lost to follow-up, the other 6 patients exhibited tumor-free survival with a median follow-up time of 13.5 months, the longest follow-up time being 24 months.

Conclusion: The patients of SLCT can present with hormonal magnification and manifest high AFP, CA125, and T levels. SLCT is characterized by a solid or mixed solid-cystic mass on CT/MR scans, and shows marked or moderated heterogeneous and constantly enhancement upon postcontrast study. The clinical characteristics and imaging findings are features and appropriated imaging should be performed whenever an SLCT is suspected.

Figure 1

SLCT in a 63-year-old woman with vaginal bleeding after 7 years of menopause. (A) Axial CT showed an isodense solid nodule (arrow) in right ovary. Unenhanced MRI showed the lesion had slightly high SI on fat saturation T2WI (B, C), and iso-SI on fat saturation T1WI (D). (E) Axial DWI (b-factor: 800 mm/s²) demonstrated high SI compared with that of the peripheral muscles. (F) Sagittal contrast-enhanced T1WI with fat saturation showed that the lesion was heterogeneous marked enhancement.

Figure 2

SLCT in a 28-year-old woman with irregular menstruation. (A) Axial CT showed an isodense solid nodule (arrow) in left ovary. Unenhanced MRI showed the lesion had slightly high SI on fat saturation T2WI (B, C), and iso-SI on fat saturation T1WI (D). (E) Axial DWI (b-factor: 800 mm/s²) demonstrated high SI compared with that of the peripheral muscles. (F) Sagittal contrast-enhanced T1WI with fat saturation showed heterogeneous marked enhancement consisting of multiple nodules with relatively homogeneous marked enhancement.

Figure 3

SLCT in a 21-year-old woman with irregular menstruation. (A) Axial CT showed a solid mass with multiple small cysts in the central tumor region. The solid component was isodense, accompanied by hemorrhagic patchy hyperdense in the tumor. On MRI, the solid component of the tumor showed high SI on fat saturation T2WI (B), slightly low SI on fat saturation T1WI (C), and high SI on DWI (D) along with hemorrhagic patchy low SI on fat saturation T2WI inside the tumor. (E) Coronal and (F) sagittal contrast-enhanced T1WI with fat saturation showed heterogeneous marked and constant enhancement.

Figure 4

SLCT in a 16-year-old woman with abdominal pain. (A) Axial CT shows a huge multilocular cystic mass with solid area and mural nodules. (B–E) Contrast-enhanced CT showing heterogeneous marked and constant enhancement.

Figure 5

The most common histological features of Sertoli–Leydig cell tumors of the ovary is Sertoli cells are arranged in hollow tubules, cords, sheets, and aggregates, and with adjacent Leydig cells showing eosinophilic cytoplasm (H&E, 200 × ).