Pseudoendometrioid Sertoli-Leydig cell tumour, Ovarian Sertoli-Leydig cell tumors with pseudoendometrioid tubules

Rarely, the tubules of Sertoli/Leydig cell tumours closely mimic endometrioid carcinoma.

Clinical features

Patients may present with symptoms attributable to oestrogen or androgen excess, including irregular vaginal bleeding, amenorrhoea or hirsutism. Some patients are in the second or third decade of life, when endometrioid adenocarcinoma would be rare.

Macroscopic appearances

The tumours are predominantly solid but may be focally cystic. The cut surface may be bright yellow/gold.

Histopathology

At least in part there are typical Sertoli cell elements comprising solid or hollow tubules, cords or diffuse sheets of cells. This subtype of Sertoli cell tumour is characterised by the presence of pseudoendometrioid tubules. These tubules are larger, may be dilated and may contain eosinophilic colloid-like material. There may be cytoplasmic clearing. Close packing of glands may produce a back-to-back appearance. If separated by fibrous stroma, the resemblance may be to an endometrioid adenofibroma. Leydig cells are also present but may not be prominent. Squamous elements and endometriosis are absent.

Immunohistochemistry

Differential diagnosis

True endometrioid neoplasms may be associated with endometriosis, with adenofibromata or show squamous foci. Typical Sertoli cell and Leydig cell elements are lacking, although the latter may be mimicked by luteinised stromal cells. The true epithelial neoplasms are positive for CK7 and EMA but negative for a-inhibin and calretinin.

• Endometrioid adenocarcinoma

• Endometrioid adenofibroma of borderline malignancy

References

1 Glenn McCluggage W,Young RH Ovarian sertoli-leydig cell tumors with pseudoendometrioid tubules (pseudoendometrioid sertoli-leydig cell tumors). Am J Surg Pathol 2007; 31:592-7

This page last revised 3.5.2007.

©SMUHT/PW Bishop