DIRECT IN-VIVO DETECTION OF ATYPICAL HORMONAL EXPRESSION OF A SERTOLI-LEYDIG CELL TUMOR FOLLOWING STIMULATION WITH HUMAN CHORIONIC-GONADOTROPIN

A 60-year-old woman presented with progressive hirsutism and elevated serum testosterone levels. Selective bilateral ovarian and adrenal vei n catheterization demonstrated mild elevated testosterone and androste nedione levels in the right ovarian vein, which increased considerably 15 minutes following intravenous injection of 5000 IU human chorionic gonadotrophin. Androgen levels decreased remarkably after administrat ion of gonadotrophin hormone releasing hormone-agonist (GnRH-a). On hi stological examination, diffuse stromal hyperplasia of both ovaries wa s noted, with a small Sertoli-Leydig cell tumour in the right ovary. T his is the first report of preoperative, direct selective diagnosis of a small Sertoli-Leydig cell tumour with such a hormonal expression. O varian Sertoli-Leydig cell tumours are rare sex cord stromal tumours t hat exhibit testicular-like structure and differentiation. These tumou rs are potentially malignant, can cause progressive virilization (Youn g & Scully, 1985), and are often clinically manifested as palpable pel vic masses and virilization (Meldrum & Abraham, 1979; Friedman et al., 1985). We describe a patient with post-menopausal virilization due to Sertoli-Leydig cell tumour, in whom a remarkable increase in androgen s was detected following intravenous human chorionic gonadotrophin inj ection, during adrenal and ovarian selective vein blood sampling. A re markable decrease in the serum androgen level was noticed following an injection of gonadotrophin hormone releasing hormone-agonist (GnRH-a) .