Sertoli-Leydig cell tumours are rare comprising 0.21.2% of all primary ovarian cancers. Virilisation is seen in 3050% of cases. Heterologous Sertoli-Leydig cell tumours with dominant cystic component are even rarer and mainly affect females aged 20 to 30 years. A 66-year-old lady was referred to the Endocrine Department with a one year history of rapid severe hirsutism involving the limbs, abdomen, chest, face and thinning of hair on the scalp. Blood pressure of 156/89 and BMI of 34. Her testosterone was raised at 11.9 nmol/l, serum cortisol was 461 nmol/l and TSH was 9.29 mu/l. Twenty-four hour urine cortisol was normal at 80 nmol (N 0146) and 1 mg overnight dexamethasone suppression test showed a morning serum cortisol of 24 nmol/l. CT scan of the abdomen showed normal adrenal glands but a large left ovarian cyst measuring 10 × 11 × 8 cm in size. Transvaginal ultrasound showed a large unilocular cyst measuring 12.7 × 8.3 × 9 cms with some thick septations seen. CA 125 was normal at 7 Ku/l (N 035). Testosterone level normalised to 0.5 nmol/l once the ovarian cyst was removed surgically and had significant improvement in hirsuitism. Initial histological analysis of the wall of the ovarian cyst was ambiguous and even after review by the Histopathology department at our tertiary centre, the two main differential diagnoses were mucinous cystadenoma with stromal luteinisation and hilar cell hyperplasia or heterologous Sertoli-Leydig cell tumour with dominant mucinous cystic component. The latter was finally the favoured diagnosis when correlated clinically.
19 Nov 2018 - 21 Nov 2018