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A 21-year-old virgin presented with abdominal discomfort and pelvic mass. Laparotomy revealed non-ruptured right ovarian tumour about 5 cm in diameter with no ascites. No extra-ovarian disease was noted intraoperatively. She underwent right salpingo-oophorectomy at a local hospital. Pathological diagnosis was right ovarian Sertoli–Leydig cell tumour with heterogeneous components. Subsequently, she received three courses of combined chemotherapy composed of bleomycin, etoposide and cisplatin, but the disease had been progressing.
At the time of admission to our hospital just 4 months later from the initial operation, her serum β subunit of human chorionic gonadotropin (β-HCG) was 258.6 mIU/ml, and other tumour markers were normal. Her serum parathyroid hormone (PTH) was 88.6 pg/ml (normal 5∼70 pg/ml), but serum calcium level was normal.
The pathology slides from her first operation were reviewed. The tumour was composed of two different components, most of which consisted of poorly differentiated medium to large tumour cells with enlarged round or oval nuclei arranged in solid cords and nests. On higher magnification, the tumours had abundant eosinophilic and granular cytoplasm, and the nuclei had coarse chromatin and prominent nucleoli (figure 1). The smaller component consisted of a strip of mucinous borderline …