CC BY 4.0 · Rev Bras Ginecol Obstet 2019; 41(07): 440-448
DOI: 10.1055/s-0039-1693056
Original Article
Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

Ovarian Sertoli-Leydig Cell Tumors: Epidemiological, Clinical and Prognostic Factors

Tumores de células de Sertoli-Leydig ovarianos: fatores epidemiológicos, clínicos e prognósticos
1  Faculdade de Ciências da Saúde de Barretos Dr. Paulo Prata, Barretos, SP, Brazil
,
Cristiano de Pádua Souza
2  Gynecologic Clinical Oncology Department, Hospital do Câncer de Barretos, Barretos, SP, Brazil
,
Carlos Eduardo Mattos da Cunha Andrade
3  Gynecologic Oncology Department, Hospital do Câncer de Barretos, Barretos, SP, Brazil
,
Marcelo de Andrade Vieira
3  Gynecologic Oncology Department, Hospital do Câncer de Barretos, Barretos, SP, Brazil
,
Diocésio Alves Pinto de Andrade
4  InORP ONCOCLÍNICAS Group (Instituto Oncológico de Ribeirão Preto), Ribeirão Preto, SP, Brazil
,
Ricardo dos Reis
3  Gynecologic Oncology Department, Hospital do Câncer de Barretos, Barretos, SP, Brazil
› Author Affiliations
Further Information

Publication History

05 February 2019

28 May 2019

Publication Date:
25 July 2019 (online)

  

Abstract

Objective To describe a series of cases of ovarian Sertoli-Leydig cell tumors (SLCTs).

Methods Retrospective review of 12 cases of SLCT treated at the Hospital do Câncer de Barretos, Barretos, state of São Paulo, Brazil, between October 2009 and August 2017.

Results The median age of the patients was 31 years old (15–71 years old). A total of 9 patients (75.0%) presented symptoms: 8 (66.7%) presented with abdominal pain, 5 (41.7%) presented with abdominal enlargement, 2 (16.7%) presented with virilizing signs, 2 (16.7%) presented with abnormal uterine bleeding, 1 (8.3%) presented with dyspareunia, and 1 (8.3%) presented with weight loss. The median preoperative lactate dehydrogenase (LDH) was 504.5 U/L (138–569 U/L), alpha-fetoprotein (AFP) was 2.0 ng/ml (1.1–11.3 ng/ml), human chorionic gonadotropin (β-hCG) was 0.6 mUI/ml (0.0–2.3 mUI/ml), carcinoembryonic antigen (CEA) was 0.9 ng/ml (0.7–3.4 ng/ml), and cancer antigen 125 (CA-125) was 26.0 U/ml (19.1–147.0 U/ml). All of the tumors were unilateral and surgically treated. Lymphadenectomy was performed in 3 (25.0%) patients, but none of the three patients submitted to lymphadenectomy presented lymph node involvement. In the anatomopathological exam, 1 (8.3%) tumor was well-differentiated, 8 (66.7%) were moderately differentiated, and 3 (25.0%) were poorly differentiated. A total of 5 (55.6%) tumors were solid-cystic, 2 (22.2%) were purely cystic, 1 (11.1%) was cystic with vegetations, and 1 (11.1%) was purely solid, but for 3 patients this information was not available. The median lesion size was 14.2 cm (3.2–23.5 cm). All of the tumors were at stage IA of the 2014 classification of the International Federation of Gynecology and Obstetrics (FIGO). A total of 2 (16.7%) patients received adjuvant treatment; 1 of them underwent 3 cycles of paclitaxel and carboplatin every 21 days, and the other underwent 4 cycles of ifosfamide, cisplatin and etoposide every 21 days. None of all of the patients had recurrence, and one death related to complications after surgical staging occurred.

Conclusion Abdominal pain was the most frequent presentation. There was no ultrasonographic pattern. All of the SLCTs were at stage IA, and most of them were moderately differentiated. Relapses did not occur, but one death related to the surgical staging occurred.

Resumo

Objetivo Descrever uma série de casos de tumores de células de Sertoli-Leydig (TCSLs) ovarianos.

Métodos Revisão retrospectiva de 12 casos de TCSL tratados no Hospital de Câncer de Barretos entre outubro de 2009 e agosto de 2017.

Resultados A mediana de idade foi 31 anos (15–71 anos). Um total de 9 pacientes (75,0%) apresentaram sintomas: 8 (66,7%) apresentaram dor abdominal, 5 (41,7%) apresentaram aumento abdominal, 2 (16,7%) apresentaram virilização, 2 (16,7%) apresentaram sangramento uterino anormal, 1 (8,3%) apresentou dispareunia, e 1 (8,3%) apresentou emagrecimento. A mediana de desidrogenase láctica (DHL) foi 504,5 U/L (138–569 U/L), alfafetoproteína (AFP) foi 2,0 ng/ml (1,1–11,3 ng/ml), gonadotrofina coriônica humana (β-hCG) foi 0,6 mUI/ml (0,0–2,3 mUI/ml), antígeno carcinoembrionário (CEA) foi 0,9 ng/ml (0,7–3,4) ng/ml, e antígeno cancerígeno 125 (CA-125) foi 26,0 U/ml (19,1–147,0 U/ml), todos pré-operatórios. Todos os tumores foram unilaterais e tratados cirurgicamente. Realizou-se linfadenectomia em 3 (25,0%) pacientes, porém, nenhuma das três apresentou acometimento linfonodal. No exame anatomopatológico, 1 tumor (8,3%) era bem diferenciado, 8 (66,7%) eram moderadamente diferenciados, e 3 (25,0%) eram pouco diferenciados. Um total de 5 (55,6%) tumores eram sólido-císticos, 2 (22,2%) eram puramente císticos, 1 (11,1%) era cístico com vegetações, e 1 (11,1%) era puramente sólido, mas para 3 pacientes estas informações não estavam disponíveis. A mediana da dimensão da lesão foi 14,2 cm (3,2–23,5 cm). Todos os tumores eram estádio IA de acordo com a classificação de 2014 da Federação Internacional de Ginecologia e Obstetrícia (FIGO, na sigla em inglês). Duas (16,7%) pacientes receberam adjuvância; uma realizou 3 ciclos de paclitaxel e carboplatina a cada 21 dias, e a outra 4 ciclos de ifosfamida, cisplatina e etoposide a cada 21 dias. Dentre todas as pacientes, nenhuma apresentou recidiva e houve um óbito relacionado a complicações após estadiamento cirúrgico.

Conclusão Dor abdominal foi a apresentação mais frequente. Todos os TCSLs eram estádio IA e a maioria era moderadamente diferenciada. Não ocorreram recidivas, mas ocorreu um óbito relacionado ao estadiamento cirúrgico.

Contributions

All of the authors contributed to the development of the present research, helped in the conception, the design, the data interpretation, and also in the critical review of the manuscript.