A 16-year-old girl presents with progressive hirsutism, deepening voice, clitoromegaly, and amenorrhoea over 8 months. Examination shows a unilateral 12 cm solid ovarian mass. Testosterone is markedly elevated; beta-hCG and AFP are normal. The most likely diagnosis is:

• A Dysgerminoma
• B Sertoli-Leydig cell tumour ✓
• C Adult granulosa cell tumour
• D Yolk sac tumour

Explanation

Sertoli-Leydig cell tumours are sex cord-stromal neoplasms that secrete androgens, producing defeminisation followed by virilisation in adolescent girls and young women. They are typically unilateral solid masses. Granulosa cell tumours secrete oestrogen and cause precocious puberty or endometrial hyperplasia, not virilisation. Dysgerminoma and yolk sac tumour are germ cell tumours that do not produce androgen; yolk sac tumour would raise AFP.

Reference: Novak's Gynecology, 16th ed.

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Written and medically reviewed by the StethoPrep medical team.