A 17-year-old girl presents with amenorrhoea, deepening of voice, and clitoromegaly of 8 months duration. Ultrasound shows a 9 cm solid left ovarian mass. Testosterone is markedly elevated. Histology reveals tubules of Sertoli cells admixed with Leydig cells containing Reinke crystals. The most appropriate management is:
- A Neoadjuvant chemotherapy followed by hysterectomy
- B Total hysterectomy with bilateral salpingo-oophorectomy
- C Unilateral salpingo-oophorectomy with staging, preserving the uterus ✓
- D Gonadotrophin-releasing hormone agonist therapy for 6 months
Correct answer: C. Unilateral salpingo-oophorectomy with staging, preserving the uterus
Explanation
Sertoli-Leydig cell tumour is an androgen-secreting sex cord stromal tumour of young women; Reinke crystals in Leydig cells are characteristic. Over 90% are Stage I at diagnosis and behave indolently, so fertility-sparing unilateral salpingo-oophorectomy with surgical staging is standard when disease is confined to one ovary. Radical surgery sacrifices reproductive potential unnecessarily, and GnRH agonists have no role as definitive therapy.
Reference: Williams Gynecology, 3rd ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.