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A Sertoli-Leydig cell tumour grows from the supporting tissue of the ovary rather than its surface lining, and it is the classic androgen-producing ovarian tumour — which is why it is often a stopped period, new facial hair or a deepening voice that brings a young woman to a doctor. It is rare, it usually affects one ovary only, and the large majority are still confined to that ovary when they are found. The grade written in your pathology report decides almost everything that follows.
It is a sex cord-stromal tumour. That means it grows from the supporting tissue of the ovary rather than from its surface lining, and it is built from cells that resemble the two cell types of a testis — Sertoli cells and Leydig cells. That is where the name comes from, and it is also why the tumour so often makes male hormone. Older reports call the same thing an androblastoma or an arrhenoblastoma.
If you have searched sertoli leydig cell tumour after reading a scan or a pathology report, most of what came back was probably about epithelial ovarian cancer — a different disease, in a woman thirty years older, with a very different natural history. This is not that. These tumours are rare, they occur mainly in teenagers and women in their twenties, they almost always involve one ovary only, and the large majority are still confined to that ovary when they are found.
Two things drive everything that follows. The first is grade: pathologists classify these tumours as well, moderately or poorly differentiated, and may note retiform or heterologous elements. That single line in the report has more bearing on your treatment than anything else in it. The second is hormone: roughly half of these tumours produce androgen, and that is often what brought you to a doctor in the first place — periods that stopped, hair where there had never been any, a voice that dropped.
It grows from the ovary's supporting stroma, not its surface lining. The CA-125-and-staging framework built around epithelial ovarian cancer does not transfer to it, and CA-125 is usually unhelpful here.
Most are diagnosed before thirty. It is distinctly unusual for both ovaries to be involved, which is the single biggest reason fertility-sparing surgery is realistic for most women.
Well differentiated tumours behave benignly and are generally cured by removing them. Moderately and poorly differentiated ones are the tumours that warrant full staging and, sometimes, chemotherapy.
Most women with this diagnosis are told it is simply rare and sporadic. The pathology of the last decade says otherwise. Moderately and poorly differentiated Sertoli-Leydig cell tumours frequently carry pathogenic DICER1 variants, and in a meaningful share of those cases the variant is germline — present in every cell, inherited, and shared with relatives. That is why current practice is to offer genetic counselling and DICER1 testing to a young woman with this tumour rather than treating it as an isolated event: DICER1 predisposition also involves the lung in early childhood, the kidney and the thyroid, and an ovarian tumour can be the first sign of it in a family. Source: WHO Classification of Tumours, Female Genital Tumours (5th ed., 2020); Schultz KAP et al., DICER1 Tumor Predisposition, GeneReviews.
Two comparisons come up constantly: with granulosa cell tumours, the other hormone-producing ovarian tumour, and with ordinary epithelial ovarian cancer, which is what almost everything written about “ovarian cancer” actually describes.
| Feature | Sertoli-Leydig cell tumour | Granulosa cell tumour | Epithelial ovarian cancer |
|---|---|---|---|
| Typical age | Teens and twenties; most before thirty | Adults, commonly forties and later | Mostly after fifty |
| Hormone made | Androgen, in roughly half of cases | Oestrogen, characteristically | None |
| How it presents | Periods stopping, new coarse hair, a deepening voice — or simply a pelvic mass | Heavy periods, or bleeding after menopause; a pelvic mass | Bloating, feeling full quickly, pelvic pain |
| Useful blood markers | Testosterone; inhibin B and AMH | Inhibin B and AMH; oestradiol | CA-125, HE4 and the ROMA score |
| Stage when found | Almost always confined to one ovary | Usually early stage | Frequently advanced |
| Relapse pattern | Early if at all, mostly within the first two years | Characteristically late, sometimes decades on | Usually within the first few years |
| Genetics to consider | DICER1, germline in a meaningful share of cases | FOXL2 within the tumour; not usually inherited | BRCA1, BRCA2 and HRD |
The comparison that matters most in clinic is with the other hormone-producing ovarian tumour: see granulosa cell tumours, which make oestrogen rather than androgen, occur in older women, and relapse late. For the disease that most published information actually describes, start with our complete guide to ovarian cancer.
For the women whose tumour makes androgen, this is usually the part they most want answered — and often the part that gets the least time in a busy clinic.
It usually begins with the periods: cycles become irregular, then stop. Alongside that come acne and greasy skin, and coarse dark hair appearing where fine hair used to be — the upper lip and chin, the chest, the lower abdomen. Further along, scalp hair thins at the temples, breast tissue reduces, the voice deepens and the clitoris enlarges.
The speed is the tell. These changes arriving over months, in a young woman whose cycles were previously regular, is a different story from mild hair growth that has crept up over years. Rapid change is what should prompt a scan of the ovaries and a testosterone level, and it is what most often leads to the diagnosis.
Polycystic ovary syndrome is common and an androgen-producing ovarian tumour is rare, so the first explanation offered for irregular periods and new hair growth is almost always PCOS. That is reasonable arithmetic, and most of the time it is right.
What separates them is degree and speed. PCOS produces mild androgen excess that builds gradually and rarely deepens the voice or enlarges the clitoris. A tumour produces a testosterone level far above the female range rather than a borderline one, and it does so over months. If the changes are rapid, or the testosterone is markedly high, the ovaries need imaging rather than a repeat prescription.
Total testosterone is the main measurement. DHEAS is added because it comes overwhelmingly from the adrenal gland, so a markedly raised testosterone with a normal DHEAS points at the ovary rather than the adrenal — a distinction that changes which scan is ordered next.
Inhibin B and anti-Mullerian hormone are also worth taking. They are not raised in every case and cannot diagnose or exclude anything on their own, but where one of them is clearly raised before surgery it becomes a genuinely useful marker afterwards. All of these should be drawn before the operation, so there is a baseline to measure the fall against.
Testosterone falls within days of the tumour being removed, and the changes reverse roughly in the order they arrived. Periods usually return within a few months. Acne and greasy skin settle over a similar period. Hirsutism fades slowly, over a year or more, and often needs dermatological treatment rather than patience alone.
Two changes may not fully reverse: a voice that has deepened, and clitoral enlargement. Some improvement is common, complete reversal is not, and this is worth hearing plainly before surgery rather than discovering afterwards. It is also one of the practical arguments for not letting a rapidly changing hormonal picture drift for another six months before anyone scans the ovaries.
Around half of these tumours are hormonally silent. They present the way any ovarian mass presents — pelvic or abdominal pain, a sense of pressure or swelling, occasionally sudden severe pain if the ovary twists — or they are found on a scan arranged for something else entirely.
A smaller number make oestrogen instead of androgen, and cause abnormal bleeding or, in a child, early puberty. Either way, the absence of virilisation says nothing about the grade or the outlook. The pathology report decides that, not the hormonal picture.
What most families need on the first day is not another test. It is forty-five minutes with someone who can say plainly what the grade in the report means, what surgery is needed, whether chemotherapy follows, and what happens to periods and fertility.
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No referral needed and no cost for the first consultation. Bring the scan and the pathology report — with an uncommon tumour, most of the questions that actually matter can be answered in one sitting.
Everything below follows from two facts: these tumours are almost always confined to one ovary when they are found, and the woman is usually young enough that keeping her fertility belongs in the plan rather than as an afterthought.
Standard surgery for a tumour confined to one ovary in a young woman is removal of that ovary and its fallopian tube, leaving the uterus and the opposite ovary in place. Removing the mass whole matters: rupturing it during surgery raises the stage and can turn a surgery-only plan into one that includes chemotherapy. Surgery of this kind is coordinated with specialist gynaecologic-oncology partner centres and may be billed there — CION arranges it and stays involved through it rather than performing it in-house, and we would rather say so at the outset than have you find out at admission.
Peritoneal washings are taken, the peritoneal surfaces, omentum and diaphragm are inspected, and anything abnormal is biopsied. Sex cord-stromal tumours spread within the abdomen rather than to lymph nodes early, so a systematic look matters more here than routine node dissection. This is also the step most often left incomplete, and incomplete staging is the usual reason a young woman ends up back in theatre for a second procedure that could have been avoided.
The final pathology takes days rather than hours, and it is worth waiting for rather than pre-empting. A well differentiated tumour, completely removed and properly staged, usually needs nothing beyond surgery and follow-up. Moderately and poorly differentiated tumours, retiform or heterologous elements, a tumour that ruptured, or disease found beyond the ovary all shift the conversation towards additional treatment.
Where it is indicated, treatment is a course of platinum-based combination chemotherapy — the same class of regimen used for other sex cord-stromal and germ cell tumours, chosen by class and mechanism rather than by any single agent. Chemotherapy is delivered in-house at CION, across 35+ centres in Telangana and Andhra Pradesh, so cycles and follow-up can happen near where you live. The wider picture is set out in our guide to ovarian cancer treatment in Hyderabad.
Because moderately and poorly differentiated tumours are frequently DICER1-associated, and a share of those variants are inherited, genetic counselling belongs in the plan rather than at the end of it. A germline result changes surveillance for you — the thyroid in particular — and gives your siblings, parents and any future children information they would otherwise not have. Genetic counselling is delivered in-house at CION, and the laboratory testing is arranged through that clinic so you are not left to organise it yourself.
Recurrence, in the tumours capable of it, tends to happen early rather than late — the opposite of granulosa cell tumours, which can return decades on. Follow-up is therefore intensive at first and eases off: clinical examination, whichever markers were clearly raised at diagnosis, and periodic imaging. Longer term it shifts towards what matters to a woman in her twenties and thirties — ovarian function, periods, planning a pregnancy, and the late effects of any chemotherapy given.
With an uncommon tumour, the early decisions are the ones that stick: a mass punctured rather than removed whole, staging left incomplete, or an ovary taken that did not need to be. If you have a report in hand and a decision to make this week, an unhurried second opinion is worth the few days it takes — book a free consultation.
The woman reading this is usually somewhere between seventeen and thirty, and there is often a parent reading over her shoulder. Frequently she has spent a year being told the hair growth and the missed periods were hormonal and would settle. What she needs on the first day is rarely another test. It is someone with the time to explain what this tumour is, what the grade in the report means, what the surgery involves, whether chemotherapy follows, and what happens to fertility — in that order, and without hedging.
Your first consultation at CION is free and runs to about 45 minutes. Bring the scan and the pathology report, and the hormone results if they were done. Every case that raises a question is discussed at a tumour board rather than settled by a single doctor, which counts for more with a rare tumour than with a common one, precisely because the early decisions are the consequential ones.
We are equally plain about who does what. Chemotherapy is delivered in-house at CION across 35+ centres, alongside genetic counselling, nutrition support, survivorship care and follow-up. Fertility-sparing surgery and surgical staging are coordinated with specialist gynaecologic-oncology partner centres and may be billed there. CION arranges that surgery and stays involved through it; we do not perform it ourselves, and you should hear that from us at the start.
One word on the numbers, since you will have looked them up. CION publishes its own one-year survival for ovarian cancer alongside the national figure: 81.0% of CION ovarian cancer patients are alive at one year, against a national figure of 73.7%. Both describe an entire treated population at one year — they are not cure rates, and not predictions for any individual. They are also dominated by epithelial ovarian cancer in women over fifty, which is a different disease from yours. Published ovarian cancer survival figures understate the outlook for a well differentiated, stage I sex cord-stromal tumour considerably. The figures worth discussing are the ones your oncologist can give you for this tumour, at this grade and stage.
Free, unhurried, and long enough to cover grade, surgery, chemotherapy and fertility in one sitting instead of across three visits.
Multidisciplinary review of the pathology and the imaging — which counts for most with an uncommon tumour, where the first decisions are the ones that stick.
Chemotherapy and genetic counselling are delivered by CION across 35+ centres in Telangana and Andhra Pradesh, so treatment and follow-up stay near where you live.
Fertility-sparing and staging surgery is arranged with specialist gynaecologic-oncology partner centres and may be billed there.
*One-year survival rates across all ovarian cancer types and stages. CION figures reflect CION's treated patient population; national figures are drawn from published Indian cancer registry data. Both are dominated by epithelial ovarian cancer and describe groups rather than individuals — discuss the outlook for a sex cord-stromal tumour specifically with your treating oncologist.
It is classified and treated as a malignant tumour of the ovary, but the honest answer depends on the grade in your pathology report. Well differentiated tumours behave benignly: they are removed, and they very rarely return. Moderately differentiated tumours sit in between. Poorly differentiated tumours, and those containing retiform or heterologous elements, are the ones genuinely capable of spreading, and they are the reason full staging and sometimes chemotherapy form part of the plan. So the word cancer covers a wide range here. The other fact worth holding onto is that the large majority of these tumours are still confined to one ovary at the point they are found, which is why the outlook is considerably better than the phrase ovarian cancer suggests to most people.
Partly, and in a fairly predictable order. Testosterone falls within days of the tumour being removed. Periods usually return within a few months, provided the other ovary and the uterus are in place. Acne and greasy skin settle over a similar period. Hirsutism improves slowly, over a year or more, and often needs dermatological treatment rather than time alone. Two changes may not reverse completely: a voice that has deepened, and clitoral enlargement. Some improvement is common; full reversal is not, and you should be told that before surgery rather than afterwards. None of this is a reason to delay treatment, and all of it is a reason not to let a rapidly changing hormonal picture drift for months before it is investigated.
Usually yes. Standard surgery for a tumour confined to one ovary removes that ovary and its tube while leaving the uterus and the opposite ovary in place, so what is needed for a pregnancy remains. Most young women resume normal periods within a few months and conceive naturally. That is the ordinary outcome rather than the optimistic one. It becomes more complicated if chemotherapy is needed for a higher-grade tumour, or in the uncommon situation where both ovaries are involved. In either case the fertility conversation belongs before treatment starts, not after the last cycle, so that preservation options can be discussed while they are still open.
By speed and by degree. PCOS is common and produces mild androgen excess that builds gradually over years: irregular cycles, some acne, some extra hair growth. It rarely deepens the voice or enlarges the clitoris, and the testosterone level is usually only modestly raised. An androgen-producing ovarian tumour does the opposite. The changes arrive over months in a woman whose cycles were previously regular, they keep progressing, and the testosterone is far above the female range rather than borderline. A normal DHEAS alongside a markedly raised testosterone points at the ovary rather than the adrenal gland. If that is the picture, the next step is imaging of the ovaries, not another cycle of hormonal treatment.
It is worth discussing in every case, and it is particularly relevant if your tumour is moderately or poorly differentiated, since those are frequently associated with pathogenic DICER1 variants. DICER1 is a gene involved in regulating how cells read their own instructions. Some of these variants exist only within the tumour, but a meaningful share are germline, meaning they are present in every cell and can be inherited. A germline result changes what is watched in you afterwards, the thyroid in particular, and gives your siblings, parents and future children information they would not otherwise have. Genetic counselling is delivered in-house at CION and the testing is arranged through that clinic, so the decision is made with a counsellor rather than alone.
The first consultation is free and runs to about 45 minutes. Bring the scan, the pathology report and any hormone results, since the grade recorded in that report changes the plan more than anything else. Chemotherapy is delivered in-house at CION across more than 35 centres in Telangana and Andhra Pradesh, alongside genetic counselling, nutrition support, survivorship care and follow-up. Fertility-sparing surgery and surgical staging are coordinated with specialist gynaecologic-oncology partner centres and may be billed there; CION arranges the surgery and stays involved through it rather than performing it in-house, and we say so upfront. Every case is reviewed at a tumour board, which matters with an uncommon tumour where the earliest decisions carry the most weight.