Comparison of the Prognostic Outcome between High-Grade Ovarian Sertoli-Leydig Cell Tumors (SLCTs) and Low-Grade SLCTs

Abstract

The purpose of the current study was to compare prognostic outcomes between patients with high-grade ovarian Sertoli-Leydig cell tumors (SLCTs) and those with other low-grade SLCTs. We retrospectively reviewed medical records for 24 patients pathologically diagnosed with SLCTs between 2006 to 2019 at two institutions. The patients were grouped according to pathological grade: SLCT was classified as grade 1, well differentiated; grade 2, intermediated differentiated; or grade 3, poorly differentiated (Meyer's classification). Statistical analysis was performed to compare survival outcomes according to pathological grade. The median patient age was 42.5 years (range 16-75). Eighteen patients (75%) were International Federation of Gynecology and Obstetrics stage I, and none were diagnosed in stage IV. Nine patients (37.5%) were grade 3, and 15 patients (63.5%) were grades 1-2. When comparing clinical baseline characteristics of the grade 1-2 group with those of the grade 3 group, only serum CA125 level at diagnosis was significantly higher in the grade 3 group (38.34 vs. 382.29, p=0.002). Five patients experienced recurrence of grade 3 disease, while no recurrence was reported in grade 1-2 disease. Four of the five recurrent patients died. In result, grade 3 ovarian SLCT showed significantly poorer prognosis than grade 1-2 disease (overall survival, hazard ratio=14.25, 95% confidence interval=1.881-108.0; log-rank p=0.010). Our findings were consistent with the concept that patients with stage I/grade 1-2 tumors have a good prognosis without adjuvant chemotherapy. Since grade 3 ovarian SLCT appears to be relatively more fatal than grade 1 or 2, patients with grade 3 SLCT might require more aggressive surgical intervention and post-treatment surveillance.

Keywords: Ovarian Sertoli-Leydig cell tumors; chemotherapy; prognosis.

Fig. 1. Pathologic comparison of ovarian Sertoli-Leydig cell tumor by pathologic grade. (A) Grade 1. Tubules of Sertoli cell and clusters of Leydig cell in intervening stroma are shown. Sertoli cells with oval to round nuclei and Leydig cells with eosinophilic cytoplasm are characterized. No atypia or mitotic activity is observed. (B) Grade 2. Typical diffuse or lobulated architectural pattern and alternating hypo and hypercellularity are observed. Hyperchromatic, oval or spindled nuclei with mild to moderate atypia are characterized. (C) Grade 3. Diffuse sheets of immature cells with moderate to marked nuclear atypia are observed. Increased mitotic activity and few Leydig cells are found.

Fig. 2. Kaplan-Meier curves of progression-free survival (A) and overall survival (B) between patients with high-grade SLCTs (n=9) and low-grade SLCTs (n=15). SLCTs, Sertoli-Leydig cell tumors.