A 19-year-old girl presents with secondary amenorrhoea, deepening of voice and acne of 8 months duration. Examination shows temporal balding, clitoromegaly, and a firm 9 cm right adnexal mass. Testosterone is markedly elevated at 420 ng/dL, DHEA-S is normal, and 17-hydroxyprogesterone is normal. Which tumour is most likely?
- A Sertoli-Leydig cell tumour ✓
- B Adult granulosa cell tumour
- C Congenital adrenal hyperplasia with incidental ovarian cyst
- D Dysgerminoma
Correct answer: A. Sertoli-Leydig cell tumour
Explanation
Sertoli-Leydig cell tumour is an androgen-secreting sex cord-stromal tumour of young women that produces a characteristic sequence of oligo-ovulation and defeminisation followed by frank virilisation. A markedly raised testosterone with normal DHEA-S localises the source to the ovary rather than the adrenal gland, excluding congenital adrenal hyperplasia. Adult granulosa cell tumour is oestrogenic and presents with bleeding or precocity, not virilisation. Dysgerminoma is hormonally silent apart from occasional beta-hCG.
Reference: Williams Gynecology, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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