Recurrent Sertoli-Leydig tumor

Dear Colleagues,

I am writing to see if any one has had any thoughts or previous experience regarding the management of a 21 year old woman with a recurrent virilising sertoli leydig tumour who has recently been referred to our centre.

07/2007  Left oophorectomy 22cm high grade tumour with heterologous embryonal sarcoma- had 3 cycles adjuvant BEP

11/2008 pelvic recurrence- RSO and hysterectomy- residual disease- had TIP X4

05/2009 recurrent disease in anterior abdominal wall and in pelvis
Re-operated on here, multiple tumour nodules within subcutaneous fat of anterior abdominal wall as well as multiple nodules of tumour in pelvis and in mesentry of transverse andsigmoid colon and small bowel.

Left with 1 cm nodules in mesentery

She is a fit and well 21 year old and I would like to know if anyone has had experience with 3rd line therapy for these tumours.The pathology demonstrates only a high grade sarcomatoid component( not rembyonal rhabdo) remaining and no sex cord elements demonstrated.

Michael Friedlander

Response # 1:

I have  no experience  of 3rd  line  but  might suggest either weekly carboplatin and  paclitaxel or else the  cispaltin etoposide schedule

Nick Reed

Response # 2:
At least ant abdominal wall should be treated with electrons to avoid tumour fungating through. Eventually she may well need palliative RT to pelvis.
Kailash Narayan
Response # 3:
Dear Michael,
I have currently a similar case here. I tried VAC - no response, then taxol weekly + avastin - 8 weeks stabilization, then progression. PEI - stabilizatoon for 2 courses then progression. She had GnRH receptors in 50% of cells while negatiove for ER and PR, so currently she is on GnRH
However, until now no real success...
Best Wishes
Andreas du Bois