Successful pregnancy in an ovarian Sertoli-Leydig cell tumor patient with heterologous elements: case report and literature review

Abstract Background: Ovarian Sertoli-Leydig cell tumor (SLCT) is an extremely rare sex–cord stromal tumor of the ovary. Notably, ovarian SLCT with mucinous epithelium and liposarcoma is even rarer.There is also evidence that the presence of heterologous elements is a poor prognostic factor of SLCTs. Very often, ovarian SLCT patient first presents with high androgen levels and sometimes a clarge mass in the pelvic cavity, making it difficult for early diagnosis. Case presentation: In this study, we reported a SLCT patient with heterologous elements and elevated the serum alpha-fetoprotein (AFP) levels. A 22-year old nulliparous female was first admitted with clinical symptoms of abdominal pain, a large mass in the pelvic cavity and elevated serum AFP levels, and for this she underwent left adnexectomy. Pathological examination revealed ovarian SLCT with intestinal type mucinous epithelium and liposarcoma, and immunohistochemical staining revealed positive staining for AFP in the intestinal type mucinous epithelium. The patient became pregnant naturally four years later, but SLCT was found in the opposite ovary with liposarcoma but no significant increase in serum AFP levels.Further, we reviewed the literature in order to improve preoperative diagnosis and evaluation of long-term prognosis of SLCTs with heterologous elements.Conclusion: The increase in serum AFP levels could be used for preoperative diagnosis of the presence of heterologous elements and the postoperative recurrence.