Abstract / Summary
Introduction: Sertoli–Leydig cell tumors (SLCT) are rare ovarian sex cord–stromal neoplasms that may produce androgens and cause progressive virilization. Recognition of this clinical presentation is important for establishing an early diagnosis and guiding appropriate treatment in young women. Case Report: A 23-year-old nulligravid woman presented with progressive abdominal enlargement and marked hirsutism over 12 months. Her menstrual cycles were regular, and she denied other symptoms suggestive of hyperandrogenism, including acne and alopecia. Physical examination revealed marked virilization and a large abdominopelvic mass. Imaging demonstrated a predominantly solid right ovarian mass measuring approximately 20 × 15 × 10 cm. Total and free testosterone were markedly elevated at 517 and 1.94 ng/dL, respectively, while DHEA-S, 17-hydroxyprogesterone and cortisol were within normal limits; other tumor markers, including CA-125, were also unremarkable. The patient underwent right adnexectomy with omentectomy and peritoneal cytological analysis by laparotomy. Histopathological examination confirmed a moderately differentiated SLCT, International Federation of Gynecology and Obstetrics (FIGO) stage IA, with no lymphovascular invasion and negative peritoneal cytology. Molecular analysis identified two pathogenic/probably pathogenic somatic DICER1 variants. The patient remained under clinical surveillance for more than three years, with no evidence of disease recurrence. Conclusion: Sertoli–Leydig cell tumors should be considered in young women presenting with progressive virilization and an ovarian mass. Early recognition of androgen excess may facilitate diagnosis and allow fertility-sparing treatment in selected patients with early-stage disease.