A rare case: Pure Sertoli cell tumor uncovered in atrophic ovary during postmenopausal vault prolapse evaluation.

Abstract

Introduction: Sertoli-Leydig cell tumors (SLCTs) are rare ovarian neoplasms, accounting for less than 0.2% of all primary ovarian tumors. Among these, pure Sertoli cell tumors (SCTs) are exceptionally rare, comprising only 4% of Sertoli-stromal tumors. While SCTs are more commonly observed in young women, they can occur across all age groups. They are often associated with estrogen or progesterone production, whereas testosterone production is extremely uncommon.

Case report: A 70-year-old postmenopausal woman with a history of hysterectomy 20 years ago presented with complaints of a vaginal bulge and reduced urine output for 4-5 months. She had a prior diagnosis of periampullary carcinoma (pT1aN0), treated with surgery and adjuvant chemotherapy using gemcitabine. Clinical examination revealed a fair general condition and unremarkable abdominal findings. Per speculum examination showed vault prolapse with third-degree cystocele and minimal rectocele but no signs of stress urinary incontinence. The patient underwent abdominal sacrocolpopexy for vault prolapse. During surgery, both atrophic ovaries and fallopian tubes were identified and removed. Histopathological examination confirmed a Stage Ia pure SCT in the right ovary, with no malignancy in the left ovary or fallopian tubes.

Conclusion: The incidental discovery of a pure SCT in an atrophic ovary during pelvic surgery in a postmenopausal woman is exceedingly rare. This case highlights the importance of meticulous intraoperative inspection and histopathological evaluation, even in asymptomatic atrophic ovaries.