Philippine E-Journals

A Masculine-Presenting Female Adolescent: a Rare Case of Poorly-Differentiated Sertoli-Leydig Cell Tumor

Sarah Abigail N. Manalang | Judith G. Cabanela | Darlene Minette Zamora

 

Abstract:

Virilization is characterized as females presenting with masculine features which include amenorrhea, oligomenorrhea, hirsutism, severe acne, clitoromegaly, breast atrophy and deepening of the voice. The probable causes of virilization in the young are adrenocortical and gonadal tumors. Sertoli-Leydig cell tumor (SLCT), also known as androblastoma, is a gonadal tumor belonging to the group of mixed sex cord - stromal tumors. This occurs in less than 0.5% of the population and presents with virilization in at least one-third of its cases. Symptoms at presentation depend on either excess of hormones or a mass-occupying lesion. The objectives of this clinical case report are to present a rare case of SLCT in an adolescent female and to discuss its diagnosis and management. We present a case of a 15-year-old nulligravid who consulted for abdominal enlargement associated with oligomenorrhea, multiple acne, hirsutism and deepening of the voice. Physical examination showed clitoromegaly and a 17x10cm abdominal mass. Transrectal sonography revealed an ovarian new growth containing both solid and cystic components with non-benign sonomorphologic features, a color score of 2, and massive ascites. Tumor markers revealed elevated levels of CA-125 and testosterone. Left salpingo-oophorectomy with peritoneal fluid cytology, bilateral lymph node dissection, infracolic omentectomy, and resection of retroperitoneal implants were done. Histopathologic report showed poorly differentiated SLCT, Stage IIIC. Chemotherapy was administered but was not completed. SLCT must always be considered in young female patients presenting with symptoms of virilization and ovarian mass for proper diagnoses and management.