Sertoli–Leydig cell tumor of the ovary: A diagnostic dilemma

•Varying histopathology of Sertoli–Leydig tumors presents a diagnostic challenge.•Degree of heterologous element differentiation is a prognostic indicator.•Alpha-fetoprotein expression is rare in Sertoli–Leydig cell tumors.•Accurate diagnosis is crucial for appropriate treatment selection.

BackgroundSertoli–Leydig cell tumors are rare sex-cord stromal tumors of the ovary that can present with a variety of histological elements, which may complicate diagnosis and treatment.CaseA 40-year-old female presenting with pelvic pain is found to have a large complex right adnexal mass and elevated alpha-fetoprotein. The mass was diagnosed as a Sertoli–Leydig cell tumor with heterologous elements including carcinoid and hepatoid components. She was treated with surgical resection followed by adjuvant chemotherapy and remains clear of disease.ConclusionPrognostic indicators for Sertoli–Leydig cell tumors include degree and type of heterologous element differentiation. Thorough characterization of such elements is crucial for adequate diagnosis and treatment.