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nbme24/Block 4/Question#26 (68.2 difficulty score)
A 10-year-old girl is brought to the ...
Ovarian Sertoli-Leydig cellsπŸ”,πŸ“Ί
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 +6 
submitted by thotcandy(80),

For anyone looking for more info:

Page 147 of Pathoma

3 types of Sex cord tumors: Granulosa-theca (follicle cells), Sertoli-Leydig, and fibroma.

G-T tumor: estrogen excess

  • Precocious puberty (prepub)
  • reproductive age: menorrhagia, metrorhagia
  • Postmeno: endometrial hyperplasia/uterine bleeding
  • minimal risk of metastasis

S-L tumor: androgen excess

  • hirsutism
  • virilization
  • reinke crystals
  • tubules and leydig cells between tubes

Fibroma: benign, fibroblasts, cause meig's syndrome

  • pleural effusion
  • ascites
  • resolves with removal of tumor
mariame  FA 19 pg 632 +  



 +3 
submitted by paperbackwriter(113),

I think what threw me off was the fact that it said "most likely" and Sertoli-Leydig cell tumor in a female just seemed like such a rarity that I figured it had to be some cells females typically have.

Keeping this in mind for future questions. If one of the answers actually fits the bill, don't pick one that you're not sure of because the correct one seems unlikely! *bangs head




 +2 
submitted by medstruggle(12),
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Wyh si ti otn aanrvio ileclolf ?slecl I htoguht hte ealefm aangol fo eoitlrS nda idgLye is ala/eosaurtnchg e.slcl

colonelred_  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +10  
brethren_md  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +4  
sympathetikey  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
s1q3t3  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +11  
masonkingcobra  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +3  
mcl  Wait, but did anyone mention that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen??? +38  
mcl  But seriously though, pathology outlines says sertoli-leydig tumor "may be suspected clinically in a young patient presenting with a combination of virilization, elevated testosterone levels and ovarian / pelvic mass on imaging studies." As for follicle cell tumors, granulosa cell tumors usually occur in adults and would cause elevated levels of estrogens. Theca cell tumor would also primarily produce estrogens. Putting the links at the end since idk if they're gonna turn out right lol Link pathology outlines for sertoli leydig granulosa cell tumor theca cell tumor +12  
bigjimbo  LOL +  
fallenistand  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +5  
medpsychosis  So after doing some intense research, UPtoDate, PubMed, an intense literature review on the topic I have come to the final conclusion that...... ...... ...... ...... Wait for it.... ..... ..... Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +9  
charcot_bouchard  Hello, i just want to add that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
giggidy  Hold up, so I'm confused - I read all the posts above but I still am unsure - are sertoli-leydig cells notorious for producing androgen? +4  
subclaviansteele  Hold the phone.....Females can get sertoli leydig cell tumors which are notorious for producing androgen? TIL TL;DR - Females can get sertoli leydig cell tumors = high androgens +  
cinnapie  I just found a recent study on PubMed saying "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +2  
youssefa  Hahahahaha ya'll just bored +9  
water  Bored? you wouldn't think so if you knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +5  
nbmehelp  I dont get it +  
redvelvet  how don't you get it that females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen? +1  
drmomo  what if this means..... females can get Sertoli Leydig cell tumors, which are notorious for producing lots of androgen +  
sunshinesweetheart  hahahaha this made my day #futurephysicians #lowkeyidiots +  
sunshinesweetheart  @medstruggle look up placental aromatase deficiency (p. 625 FA 2019), it would have a different presentation +  
deathbystep1  i am sure i would ace STEP 1 if i only knew that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +2  
noplanb  Wait... I might actually never forget this now lol +3  
drmohandes  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen. +1  
lilmonkey  Don't forget that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! You're welcome! +  
drpatinoire  Now I get it that females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens. Thank you very much.. So why choose Sertoli-Leydig cell tumor again? +  
dr_ligma  The reason is because females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of androgens! This is easy to remember, as you can remember it through the simple mnemonic "FCGSLCTWANFPLOA" which stands for "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!" +18  
minion7  after receiving a f*king score..... this post made me smile and thanks to the statement-- females can get sertoli-leydig cell tumours, which are notorious for producing lots of androgen! +1  
djtallahassee  My worthless self put adrenal zona fasciculate but now I will never forget that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen +1  
medguru2295  Wait..... so can females get Sertoli Leydig cells that produce androgens then?????? +  
peqmd  Going to snapshot this to my anki deck card: "females can get Sertoli-Leydig cell tumors, which are notorious for producing lots of {{c1::androgens}}" +1  
paperbackwriter  Watch me f*ck up the fact that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgens on the real deal. +2  
alexxxx30  just made sure to add to my notes "Females can get sertoli leydig cell tumors, which are notorious for producing lots of androgens" +2  
peridot  I also just wanna add that if you look on in FA on p.696969, you'll see that they'll mention "Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen" +  
mbate4  According to the literature [lol] females can get sertoli-leydig cell tumors, which are notorious for producing lots of antigens +  
drdoom  the tradition lives on +1  
jamaicabliz  Wait... so for clarification, is it that females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen? Or that Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen?? HELP +  
abkapoor  Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen sorry for bad Englesh +  
faus305  Sertoli-leydig cells are notorious for producing lots of androgens, females can get these. +  
djeffs1  the fact that a bunch of medstudents can get so weird about how females can get sertoli-leydig cell tumors: notorious for producing lots of androgens- just made my week!! I love you guys +  

So, after reading all the posts from scholars I have finally come to the conclusion that,

"Females can get sertoli-leydig cell tumors, which are notorious for producing lots of androgen!"

+14/- bk2458(14),


 +2 
submitted by an_improved_me(16),

I think its also help to eliminate the other answers.

Adrenal fasciulata cells (producing adrenal androgens) can be eliminated b/c this pt has adrenal androgens in the normal ranges. If you wanted to make the leap that adrenal androgens could be peripherally converted to stronger androgens (testosterone/DHT), then the inciting adrenal androgens should also be elevated.

Glomerulosa: would produce aldosterone. Though we aren't given her aldo levels, her Sx wouldn't match a Conn's syndrome picture.

Ovarial Follicle cells: have the enzymatic machinery to produce androstenedione (theca cells, its downstream cholesterol product, DHEA, is not elevated) and estrogen (granulosa cells), which doesn't fit the clinical picture this pt has.

Acidophilic hormones (prolactin/GH) are not consistent with this pt clinical picture (like gigantism, galactorrhea)

Basophil (all the others) again, not consistent, even with the gonadotropic cells, since we see LH is low. That leaves you with (D), which as others have pointed out, is consistent with this pt's presentation.




 +0 
submitted by kbizzitt(4),

Article describing Sertoli-Leydig cell tumor

https://www.medscape.com/viewarticle/565147_2