A 19-year-old woman presents with amenorrhoea, deepening voice, acne, and clitoromegaly. Imaging shows a 9 cm solid right ovarian mass. Serum testosterone is markedly elevated; AFP, beta-hCG, LDH and inhibin are normal. Histology shows tubules lined by Sertoli cells with intervening clusters of Leydig-type cells, some containing Reinke crystals. What is the diagnosis?
- A Leydig cell tumour
- B Lipid cell (steroid cell) tumour, NOS
- C Sertoli-Leydig cell tumour ✓
- D Gynandroblastoma
Correct answer: C. Sertoli-Leydig cell tumour
Explanation
The Sertoli-Leydig cell tumour (androblastoma) occurs in young women and virilises through testosterone secretion. The defining histology is Sertoli cell tubules admixed with Leydig cells, and Reinke crystals within the Leydig cells are the pathognomonic feature cited in standard texts. A pure Leydig cell tumour consists solely of Leydig cells without tubular differentiation. Most are stage I and well differentiated, so fertility-sparing surgery with removal of the involved ovary is usually adequate.
Reference: Robbins and Cotran Pathologic Basis of Disease, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.