title: Ovarian Sertoli-Leydig cell tumor with heterologous gastrointestinal epithelium as a source of alpha-fetoprotein: a case report.
abstract: Ovarian Sertoli-Leydig cell tumors (SLCT) are rare sex cord stromal neoplasms. To date there have been approximately 25 case reports of ovarian SLCT expressing alpha-fetoprotein (AFP). In such cases, AFP was immunohistochemically detected in the Sertoli cells, Leydig cells, or hepatocytes. This case report confirms heterologous gastrointestinal epithelium expression of AFP. A 20-year-old woman presented with complaints of abdominal enlargement and irregular menstrual cycles over one year. A right ovarian tumor was detected and the patient's serum AFP was elevated. A right salpingo-oophorectomy was performed. On microscopic examination, the tumor was composed of a fibrosarcoma-like area and a poorly differentiated SLCT area with heterologous gastrointestinal epithelium. Immunohistochemical analysis detected AFP in the gastrointestinal epithelium only. Postoperatively, serum AFP levels fell to normal. A recurrent tumor was discovered in the omentum after adjuvant chemotherapy, but serum AFP remained normal. A second laparotomy was performed and the recurrent tumor showed only fibrosarcoma-like features. The patient received second line chemotherapy and is currently in remission. This is the first case of AFP production by heterologous gastrointestinal epithelium in SLCT.
authors.affiliation: Department of Obstetrics and Gynecology, Fukushima Medical University School of Medicine, Fukushima, Japan. t-wata@fmu.ac.jp
authors.forename: Takafumi
authors.initials: T
authors.lastname: Watanabe
authors.forename: Hidekazu
authors.initials: H
authors.lastname: Yamada
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Morimura
authors.forename: Masafumi
authors.initials: M
authors.lastname: Abe
authors.forename: Teiichi
authors.initials: T
authors.lastname: Motoyama
authors.forename: Akira
authors.initials: A
authors.lastname: Sato
mesh_terms: D000328:Adult; D017024:Chemotherapy, Adjuvant; D004847:Epithelial Cells / Q000737:chemistry; D005187:Fallopian Tubes / Q000601:surgery; D005260:Female; D041981:Gastrointestinal Tract / Q000737:chemistry*; D006801:Humans; D009852:Omentum / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000737:chemistry / Q000175:diagnosis* / Q000601:surgery; D010052:Ovariectomy; D010534:Peritoneal Neoplasms / Q000556:secondary / Q000601:surgery; D012074:Remission Induction; D018310:Sertoli-Leydig Cell Tumor / Q000737:chemistry / Q000175:diagnosis* / Q000601:surgery; D000509:alpha-Fetoproteins / Q000032:analysis*
chemical_list: D000509:alpha-Fetoproteins