Ovarian Sertoli-Leydig cell tumors with a retiform pattern: a problem in histopathologic diagnosis. A report of 25 cases.

A review of 232 cases of ovarian Sertoli-Leydig cell tumors yielded 25 that contained a prominent component with a retiform pattern. A lack of awareness of this pattern, which has not been described adequately in the literature, resulted in frequent initial misinterpretation of these tumors as neoplasms of other types, including endodermal sinus tumor (seven cases) and serous adenocarcinoma (four cases). The patients ranged in age from 2 to 39 years. Three of them (12%) presented because of androgenic manifestations; most of the remainder complained of abdominal swelling or pain, but one of them was amenorrheic and hirsute and three had amenorrhea, suggesting androgen secretion by the tumor. All the tumors were Stage I; one was bilateral. Their average maximum dimension was 16 cm and they were typically cystic or both cystic and solid. In eight tumors the cysts were lined by papillae, which were edematous in five cases. On microscopic examination the retiform pattern, which predominated in 14 of the 25 tumors, was characterized by an irregular network of elongated, often slit-like tubules and cysts, which often contained papillae and resembled the rete testis. Follow-up of 21 patients from 6 months to 17 years (average 4 years) revealed that 16 of them were alive and free of disease; five had died of tumor from 6 months to 17 years postoperatively.