Reproductive Medicine & Surgery, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India.
Chennai, Tamil Nadu, India.
BMJ Case Rep. 2024 Oct 8;17(10):e261335. doi: 10.1136/bcr-2024-261335.
A nulligravida in her 30s presented with primary infertility and secondary amenorrhoea. General examination revealed virilisation; sonological examination detected a right ovarian solid mass. International Ovarian Tumour Analysis (IOTA) was suggestive of malignancy and serum testosterone was raised. A strong clinical suspicion and negative tumour markers pointed towards androgen producing sex cord stromal ovarian neoplasm. MRI excluded pelvic lymphadenopathy. Given the patient's desire for conception, fertility sparing staging laparotomy was done. Histopathology confirmed Sertoli-Leydig cell tumour (SLCT) International Federation of Gynaecology and Obstetrics stage IA. Serum testosterone fell drastically by day 10. Spontaneous menstruation resumed within 30 days. The significance of SLCTs as a differential diagnosis in young women with secondary amenorrhoea and virilising features underscores the role of fertility-preserving surgery in certain circumstances. Here we discuss the clinical features, diagnostic challenges and management strategies for SLCTs, emphasising the need for multidisciplinary collaboration and option of fertility preservation in early stages.
一位 30 多岁的初产妇因原发性不孕和继发性闭经就诊。一般检查发现有男性化表现；超声检查发现右侧卵巢实性肿块。国际卵巢肿瘤分析（IOTA）提示为恶性肿瘤，血清睾酮升高。强烈的临床怀疑和阴性肿瘤标志物指向产生雄激素的性索间质卵巢肿瘤。MRI 排除了盆腔淋巴结病。鉴于患者有怀孕的愿望，进行了保留生育能力的分期剖腹手术。组织病理学证实为 Sertoli-Leydig 细胞瘤（SLCT）国际妇产科联合会（FIGO）IA 期。血清睾酮在第 10 天急剧下降。30 天内恢复自发性月经。SLCT 作为年轻女性继发性闭经和男性化特征的鉴别诊断意义，强调了在某些情况下保留生育能力手术的重要性。在这里，我们讨论了 SLCT 的临床特征、诊断挑战和管理策略，强调了多学科合作的必要性和早期保留生育能力的选择。
