Ovarian Sertoli-Leydig cell tumors with heterologous elements. II. Cartilage and skeletal muscle: a clinicopathologic analysis of twelve cases.

Twelve ovarian Sertoli-Leydig cell tumors that contained heterologous elements in the form of skeletal muscle (nine cases), cartilage (seven cases) and neuroblastoma (one case) in either the primary of recurrent specimens are reported. Four of the primary tumors also contained foci of gastrointestinal type epithelium with argentaffin cells identifiable in two of them. The age of the patients ranged from 11-48 years (average, 24 years). Ten patients presented with an abdominal mass, one with abdominal pain and one with acute abdominal symptoms. Five of the patients, two of whom were virilized and one of whom was hirsute, had evidence establishing or suggesting androgen overproduction. All the tumors were unilateral. Four had ruptured preoperatively and two ruptured during the operation. The tumors averaged 18.5 cm in greatest diameter and had extensive areas of hemorrhage and necrosis in half the cases. On microscopic examination the Sertoli-Leydig cell component was poorly differentiated in 11 cases and of intermediate differentiation in one case. In two cases the primary tumor was a poorly differentiated Sertoli-Leydig cell tumor and heterologous elements were identified only in a recurrent mass. Follow-up of ten patients revealed that eight of them had died of tumor from five months to seven years postoperatively.