A 19-year-old woman presents with amenorrhoea, deepening voice, acne and clitoromegaly over 8 months. Ultrasound shows a 7 cm solid left adnexal mass. Testosterone is markedly elevated; DHEAS is normal; inhibin B is raised. Histology shows tubules lined by Sertoli cells with intervening Leydig cells containing Reinke crystals. Which tumour is this?

• A Steroid cell tumour, NOS
• B Adult granulosa cell tumour
• C Leydig cell (hilus cell) tumour
• D Sertoli-Leydig cell tumour ✓

Explanation

The combination of virilisation in a young woman, a solid ovarian mass, and histology showing both Sertoli tubules and Leydig cells with Reinke crystals defines a Sertoli-Leydig cell tumour, usually of intermediate differentiation. Raised inhibin reflects its sex cord-stromal origin. Normal DHEAS argues against an adrenal source. Pure Leydig cell tumours lack the Sertoli tubular component seen here, excluding option C.

Reference: Berek and Novak's Gynecology, 16th ed.

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Written and medically reviewed by the StethoPrep medical team.