title: Sertoli-Leydig cell tumor with unique nail findings in a post-menopausal woman: a case report and literature review.
abstract: BACKGROUND
  Sertoli-Leydig cell tumor (SLCT) is a rare sex-cord tumor that usually occurs unilaterally and accounts for < 0.5% of all ovarian tumors. SLCT is uncommon in post-menopausal women, with the average age of diagnosis being 25 years.
  
  
  METHODS
  We present a case of a 63-year-old post-menopausal woman presenting with progressive hirsutism, and male-pattern baldness. Unusual nail changes were also observed.
  
  
  METHODS
  Hormonal profile of the patient revealed increased testosterone and estradiol levels, and a 3.5 cm left ovarian mass. The patient was evaluated and was not found to be anemic or iron-deficient. Intraoperative frozen section assessment during laparoscopic exploration revealed SLCT, which was confirmed subsequently by histopathological and immunohistochemical (IHC) examination. Nail bed tissues were collected from normal females and evaluated by IHC for the presence of androgen receptors (AR).
  
  
  RESULTS
  The patient had an excellent postoperative course and all her testosterone-related manifestations were reversed within one year of surgery. Following surgery, the patient's unique nail abnormalities also resolved gradually. The IHC evaluation also confirmed the presence of AR in nail bed tissues of females.
  
  
  CONCLUSIONS
  SLCT, albeit rare, should be considered in post-menopausal women presenting with virilization and elevated androgen levels. Unusual nail signs may develop in response to increased androgen levels in these patients.
authors.forename: Dalia
authors.initials: D
authors.lastname: Moghazy
authors.forename: Chakradhari
authors.initials: C
authors.lastname: Sharan
authors.forename: Malika
authors.initials: M
authors.lastname: Nair
authors.forename: Cassandra
authors.initials: C
authors.lastname: Rackauskas
authors.forename: Robert
authors.initials: R
authors.lastname: Burnette
authors.forename: Michael
authors.initials: M
authors.lastname: Diamond
authors.forename: Omar
authors.initials: O
authors.lastname: Al-Hendy
authors.forename: Ayman
authors.initials: A
authors.lastname: Al-Hendy
mesh_terms: D001706:Biopsy; D005260:Female; D006628:Hirsutism / Q000209:etiology; D006801:Humans; D017588:Hyperandrogenism / Q000150:complications / Q000209:etiology; D007150:Immunohistochemistry; D008875:Middle Aged; D009262:Nails / Q000378:metabolism / Q000473:pathology*; D010051:Ovarian Neoplasms / Q000175:diagnosis* / Q000601:surgery; D017698:Postmenopause; D011944:Receptors, Androgen / Q000378:metabolism; D018310:Sertoli-Leydig Cell Tumor / Q000175:diagnosis* / Q000601:surgery
chemical_list: D011944:Receptors, Androgen