Challenges in diagnosing ovarian sertoli-leydig cell tumors: A Peruvian case series

Introduction: The virilizing ovarian tumors represent less than 1% of ovarian tumors, with the most common being Sertoli-Leydig cell tumor (SLCT). This stufy is a case series. Methods: We present the diagnosis, treatment, and evolution of 2 Peruvian women who developed virilization. Results: Case 1 is a 27-year-old woman with a history of polycystic ovary syndrome (PCOS), whose usual treatment was combined oral contraceptives, which she discontinued in the last year; she presented with voice changes, increased muscular strength, and acne of 6 months duration. Physical examination revealed only clitoromegaly. Tests showed elevated total testosterone, normal dehydroepiandrosterone sulfate (DHEA-S), and transvaginal ultrasound with isoechoic image in frosted glass in the left ovary. Left salpingo-oophorectomy was performed, revealing SLCT. Case 2 is a 48-year-old woman with a history of PCOS since the age of 25, prediabetes, and dyslipidemia; she noticed progression of hirsutism, increased libido, deepened voice, alopecia, weight gain, and amenorrhea over the last 5 years. Physical examination revealed hirsutism, alopecia, and clitoromegaly. Tests showed markedly elevated total testosterone (1,080 ng/dl) and normal DHEA-S. Transvaginal ultrasound showed a larger right ovary, without tumor. Ovarian venous sampling showed lateralization towards the right ovary. Bilateral salpingo-oophorectomy plus hysterectomy was performed, revealing SLCT in the right ovary. In both post-surgery patients, there was normalization of androgens and clinical improvement. Conclusions: SLCT s can occur at any age, with rapidly evolving hyperandrogenism and/or virilization symptoms, the cases described were of unusual presentation, which posed a diagnostic challenge.