A Retrospective Clinical Study Of Ovarian Sertoli-Leydig Cell Tumor And Review Of Literature

Sertoli-Leydig cell tumors (SLCTs) are rare ovarian neoplasms that belong to the group of sex-cord stromal tumors of the ovary. SLCTs account for0.2-0.5%of all primary ovarian tumors. These tumors are unilateral and most common in young women.The common clinical manifestations in these patients are hormone-related symptoms and abdominal mass. As these tumors are found at an early stage and in young women, fertility-sparing surgery is usually recommended. The prognosis of SLCTs is good, FIGO stage and grade are important prognostic factors for this disease.These rare tumors have different histological types. Not until we know more about the clinicopathologic features, diagnosis and treatment will we be able to improve management of these patients.Objective:The purpose of the present study was to review SLCTs to analyze their clinical and pathologic features, diagnosis and various treatments in order to establish the optimal management for patients.Materials and Methods:A retrospective study of SLCTs was performed including all the patients admitted to Obstetrics and Gynecology Hospital of Fudan University from July2003to July2012. Telephone interviews were used to investigate the information on prognosis. The clinical data of18cases with SLCTs were statistics analyzed.Result:The median age of SLCT patient was35years. The main clinical presentation was hormone-related symptoms (72.3%), such as features of virilization, secondary amenorrhea, irregular menses and so on. About16.7%of patients showed asymptomatic. The serum testosterone was tested in4cases, higher than the normal levels. Serum AFP and CA125increases in2cases and1case, respectively. However, they dropped back to normal after operation. On histological examination,83.3%of the rumors were of intermediate and poor differentiation,11.1%were retiform and 22.2%contained heterologous (mucinous) element. Compared with hormone-related group and the group without endocrine functions presented with difference that was not statistically significant (P>0.05).The diagnosing result of frozen sectioning examinations is different from regular pathological examinations in4cases. The reaction to inhibin is active in12cases while calretinin is positive in7cases.Of the18cases,5cases had surgical staging and FIGO stage was1A.50%of patient received fertility-sparing surgery and had a good prognosis. Bilateral pelvic lymphadenectomy was performed in4cases and peritoneal washings for cytology in3cases. There was no evidence to support metastases of the tumor.12cases with intermediate and poorly differentiated types of tumor received adjuvant chemotherapy. We found that there was no significant difference in the rate of survive between the group receiving chemotherapy and the group without chemotherapy (p>0.05).The median follow-up period was2.5years.2cases were lost and83.3%of the patients were survival.Conclusion:SLCTs of the ovary are usually common in the young women. These tumors should be suspected in young women with symptoms of virilization and pelvic mass. Fertility preserving surgery in young women is the treatment option as most of these tumors are confined to one ovary at the time of diagnosis. Patients with poor prognostic factors usually need adjuvant chemotherapy. FIGO stage and grade are important prognostic factors for this tumor. The serum testosterone is commonly used as a marker for monitoring this disease.