Sertoli-Leydig Cell Tumors of the Ovary

Sertoli-Leydig cell tumors (SLCTs), also called Sertoli-stromal cell tumors are very uncommon and make up approximately 0.5% of all ovarian tumors. Normally, these tumors affect women under the age of 30, although they have been reported in all age ranges.  These tumors can be benign (noncancerous) or malignant (cancerous.)

Hormone Producing Tumors

SLCTs can produce hormones, usually female hormones. However, in about one-third of cases, women develop signs of androgen (male hormones) overproduction, a process known as masculinization. When this happens, the tumor is known as “ androblastoma” or “arrhenoblastoma." These names apply only to cases where the tumors are overproducing male hormones.

Signs of masculinization include absent menstrual periods, lack of breast development or breast shrinkage, excessive acne, excess hair growth on the face and chest, male-pattern bald spots, deepening of the voice, and enlargement of the clitoris. Although rare, abnormal uterine bleeding can also occur.

Subtypes

These tumors are categorized into four subtypes, based on how they look under the microscope. These factors are tumor grade and a particular pattern or appearance that the pathologist can identify:

1. Well-differentiated (grade 1)
2. Intermediately differentiated (grade 2)
3. Poorly differentiated (grade 3)
4. Retiform pattern (a very characteristic appearance under the microscope)
Fortunately, more than 97% of SLCTs are grade I. In other words, they are found very early in the overwhelming majority of cases.

Treatment

Surgical removal of the affected ovary is the most common treatment -- and usually all the treatment that is necessary. That's because more than 75% of these tumors are found early (grade I) and in only one ovary.

If the cancer is found in a more advanced stage, chemotherapy and radiation after surgical removal of the ovaries may be recommended. Also, the surgery is more extensive, including removal of the uterus, both ovaries, and any other visible tumors in the lymph nodes or inside the abdominal cavity.

However, keep in mind that because of the rarity of this type of advanced cancer, there are no research-backed guidelines on the best types of radiation and chemotherapy treatments.

Prognosis

In general, the prognosis (long-term outlook) and chances for a cure depend upon the stage and grade of the tumor. By definition, all tumors that have spread beyond the ovary are considered malignant (or cancerous).

Recurrence

Recurrence is linked to two things: rupture or leakage of the tumor before or during surgery, and if the woman has the very rare retiform pattern mentioned above. Normally, when SLCTs recur, the recur soon after treatment -- in fact, almost two-thirds recur within the first year after treatment. After five years, the recurrence rate drops to 6%. If it's been five years and you've had no recurrence, you can take that as a pretty good sign that you will remain free of this type of cancer.

Coping

Coping with an ovarian tumor is difficult enough - but when you are young it feels even more unfair.  Be your own advocate in your care, and ask a lot of questions.. Ask about any clinical trials for ovarian cancer.  Sertoli-Leydig cell tumors are uncommon so you may not have a support group in your community, but many excellent ovarian support communities are available online for these less common tumors.  Ask for help.  Let people support you.  Keep in mind that one of the best gifts you can give others is to accept and express gratitude for what you are given.