Endocrine Abstracts

Introduction and importance: Ovarian Sertoli-Leydig cell tumors (SLCT) are rare sex cord-stromal tumors, representing less than 0.5% of all ovarian malignancies. Typically diagnosed at a young age, with 75% of patients having an average onset age of less than 30, these tumors often present a management challenge due to their early detection in young women. The primary dilemma lies in striking the right balance between implementing an effective treatment to prevent recurrences and preserving fertility. Notably, the majority of these tumors produce hormones, with up to 80% of ovarian Sertoli-Leydig cell tumors manifesting signs of virilization.

Case presentation: We report the case of a 28-year-old patient, followed for secondary amenorrhea evolving for 4 years, with a moderate hirsutism scored at 23 according to the Ferriman and Hallway scale, without signs of virilization. The biological assessment revealed elevated testosterone levels at 6.91 ng/ml, confirmed in three subsequent tests. Other hormonal markers, including Delta 4 androstenedione, DHEA sulfate, 17-OH hydroxyprogesterone, and tumor markers (CA 125, ACE, AFP) returned negative results. In terms of morphological assessment: Abdominopelvic CT scan: A pelvic tissue mass measuring 64 mm, probably of ovarian origin. Pelvic MRI: A tissue mass above and lateral to the left uterus of ovarian origin, with a suspicious appearance of malignancy. The case was discussed in a multidisciplinary consultation meeting, and the patient initially underwent a left annexectomy; the histopathological examination revealed a moderately differentiated Sertoli-Leydig tumor.

Conclusion: In conclusion, ovarian Sertoli-Leydig cell tumors remain rare entities, often posing diagnostic challenges due to their low incidence. Early recognition of these tumors, especially in the context of virilization, is crucial for optimal management. Their secretory nature, the need for histological confirmation post-surgery, and the prognosis linked to the degree of cellular differentiation underscore the importance of a multidisciplinary approach. Treatment, primarily surgical, may be supplemented with adjuvant chemotherapy, and postoperative follow-up is essential due to the risk of recurrence.