Management of Sertoli-Leydig Cell Tumor

Surgical Management

The American College of Surgeons recommends performing unilateral salpingo-oophorectomy with preservation of the contralateral ovary and uterus for young patients with apparently localized disease 1, 2, 3
Surgical staging procedures should include careful examination of the abdominal cavity, infracolic omentectomy, biopsy of diaphragmatic peritoneum, paracolic gutters, pelvic peritoneum, and peritoneal washings 3, 4
Systematic lymphadenectomy is not required for Sertoli-Leydig cell tumors due to the very low incidence of retroperitoneal metastases in early-stage disease 3, 4
The American College of Surgeons suggests that a laparoscopic approach is acceptable in selected cases, as it is minimally invasive with faster recovery, though care must be taken to avoid tumor rupture 5

The National Comprehensive Cancer Network recommends that adjuvant chemotherapy should be considered only for poorly differentiated tumors (Grade 3) 7, stage IB or higher (beyond stage IA) 5, or presence of high-risk features
The European Society for Medical Oncology suggests that BEP (bleomycin, etoposide, and cisplatin) is the standard first-line regimen for 3-4 cycles 2, 7
The American Society of Clinical Oncology notes that bleomycin should not be given to patients >40 years old or those with pre-existing pulmonary disease due to toxicity concerns 6

The American College of Obstetricians and Gynecologists recommends careful long-term follow-up as there is risk of relapse as late as 20 years after initial diagnosis 1, 2, 8
Clinical examination for signs of recurrence or hormonal changes, and imaging surveillance (though specific intervals are not definitively established in guidelines) are recommended 1
Tumor markers have limited utility but may include inhibin, testosterone levels if initially elevated 1, 2

The Society of Gynecologic Oncology states that stage at diagnosis remains the most important prognostic factor for Sertoli-Leydig cell tumors 3, 4
Poor differentiation (Grade 3) 6, retiform pattern 5, and tumor rupture or higher stage 2 are additional poor prognostic factors

The American College of Surgeons advises against performing radical surgery (bilateral salpingo-oophorectomy with hysterectomy) in reproductive-age patients with stage IA disease, as this compromises fertility without improving outcomes 1, 3
The National Comprehensive Cancer Network recommends against routinely administering adjuvant chemotherapy for stage IA well- to moderately-differentiated tumors without high-risk features, as there is no evidence of benefit 1, 2
The Society of Gynecologic Oncology suggests against performing systematic lymphadenectomy as it does not affect prognosis and adds morbidity 3, 4
The American College of Obstetricians and Gynecologists advises against discontinuing follow-up prematurely, as relapses can occur up to 20 years later 1, 2