A 27 year old nulliparous woman with a history of chronic
anovulation and signs of
virilization with a markedly elevated serum level of
testosterone, underwent a
laparotomy with peroperative bilateral ovarian vein catheterization and bilateral bisection of both ovaries. A solid, 1.5 cm, well delimited
tumor located centrally in the right ovary, was excised.
Testosterone levels in ovarian venous blood from the
tumor bearing side, were 88.4 nmol/l and from the contralateral ovary 3.9 nmol/l. Histopathological examination showed a
Sertoli-Leydig cell tumor which was radically extirpated. Postoperatively, the serum levels of
androgen normalized, the woman had regular cycles, became pregnant and delivered a normal female baby. Pieces of
tumor tissue were incubated for 2 h, with and without addition of
gonadotropins and
adrenocorticotropic hormone (
ACTH).
Human chorionic gonadotropin (CG),
follicle stimulating hormone (FSH) and
adrenocorticotropic hormone (
ACTH) caused significant increases in cyclic monophosphate (cAMP) production in
tumor tissue in vitro, as compared to controls. Furthermore,
ACTH also significantly stimulated
17 beta-estradiol production. In tumor cells cultured for 48 h, FSH slightly, but not significantly, increased the production of
progesterone. In the cell culture, [3H]-
thymidine incorporation into
deoxyribonucleic acid (
DNA) was stimulated by IGF1 alpha but not by hCG and FSH. It is concluded that
Sertoli-Leydig cell tumors may be sensitive to
gonadotropins and
ACTH and that their small size, solid shape and intra-ovarian localization can cause diagnostic difficulties.