Ovarian Sertoli-Leydig cell tumor

Last revised by Jeremy Jones on 25 Sep 2021

Ovarian Sertoli-Leydig cell tumors (SLCT), also known as ovarian androblastomas, are a subtype of ovarian sex cord-stromal tumor.

They are rare and only account for ~0.5% of all ovarian tumors. While they can present at any age, they typically present <30 years old, with a mean age of 14 years.

In ~30-50% of patients, the presenting symptoms are related to clinical signs of androgenic activity 6. Many patients have symptoms of virilization depending on the quantity of androgen production. A small subset is hyperoestrogenic.

Hormonally inactive tumors often have a nonspecific presentation such as an abdominal mass and/or pain. The majority of patients present with stage I disease.

Most tumors are unilateral (>90% of cases) and confined to the ovaries. These tumors are characterized by the presence of testicular structures that produce androgens. However, only 30% are hormonally active.

Ovarian SLCTs can be divided into four subtypes:

  • well-differentiated
  • intermediately-differentiated
  • poorly-differentiated
  • retiform

The tumors may contain heterologous elements in approximately 20% of cases. These can, in turn, be further separated into two basic types: endodermal and mesenchymal. Heterologous hepatic differentiation is responsible for elevated AFP levels 11.

SLCTs are usually unilateral.

Imaging features are nonspecific and variable. SLCT may manifest as a well-defined, enhancing solid mass 3 or as a cystic lesion 6. It typically presents as a solid mass with intratumoral cysts.

The signal intensity on T2-weighted MR images depends on their fibrous content. Most tumors demonstrate predominantly low T2 signal intensity with scattered areas of high signal intensity 5.

Most tumors are benign although ~10-20% can be malignant.

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Cases and figures

  • Case 1: in left ovary
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