A case of successful salvage chemotherapy of recurrent ovarian sertoli-leydig cell tumor
A 57-year-old multiparous woman presented with abdominal distension for one year. Her menopause was at 50 years of age. On physical examination, the abdomen was distended with a large pelvic mass. A computed tomography (CT) scan of the abdomen and pelvis revealed a 16.0×11.5 cm complex cystic and solid pelvis. Laboratory tests revealed an elevated serum CA-125 (113.5 U/mL). Other tumor markers including α-fetoprotein, lactate dehydrogenase, carcinoembryonic antigen and CA-19-9 were within the normal range.\nAn exploratory laparotomy was performed with findings of a mobile complex left ovarian mass, and no evidence of disease spread. Frozen biopsy revealed sex-cord stromal tumor. A total abdominal hysterectomy with bilateral salpingo-oophorectomy, peritoneal cytology, total omentectomy, incidental appendectomy, peritoneal biopsy, and pelvic and para-aortic lymph node dissection was performed. The permanent histopathologic exam confirmed a Sertoli-Leydig cell tumor of the left ovary, with intermediate differentiation and retiform elements (). The right salpinx was involved by the tumor cells and the peritoneal cytology was positive for tumor cells. Preoperative and postoperative hormone studies were within the normal range. The patient received three cycles of chemotherapy with bleomycin, VP16, and cisplatin. After eight months, a follow-up CT showed a newly developed irregularly-shaped mass around the hepatic flexure. The serum CA-125 level was 42.32 U/mL. She received twelve cycles of chemotherapy with paclitaxel and carboplatin. A CT scan after completion of the second-line chemotherapy showed complete remission of the recurrent lesion and the serum CA-125 level returned to the normal range. The patient was started on follow-up visits, and the patient was disease-free 51 months after completion of salvage treatment.