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Figure 11a. Ovarian carcinoid with testosterone-producing stroma in a 54-year-old woman. (a) Sagittal T2-weighted MR image shows a multilocular cystic mass with fluid of varying signal intensities in the lower abdomen. The mass contains a relatively large mural nodule (arrows), which has low signal intensity. (b) Sagittal contrast-enhanced T1-weighted MR image shows that the nodule has homogeneous enhancement (arrows). The patient had hirsutism and slight clitoromegaly. Laboratory data showed increased concentrations of serum testosterone (371.2 ng/dL [12.9 nmol/L]). Therefore, the preoperative radiologic diagnosis was a Sertoli-Leydig cell tumor. The cut surface of the resected specimen showed a multilocular cystic mass with a large white mural nodule. (c) Low-power photomicrograph (H-E stain) reveals medium-sized tumor cells proliferating in a solid and insular pattern accompanied by a delicate fibrous stroma. The tumor was positive for neuroendocrine markers at immunohistochemical staining, which helped determine the diagnosis of ovarian carcinoid. (d) High-power photomicrograph shows that the stroma is also positive for 
-inhibin stain (arrows), a finding that indicates that the stroma produces androgen. The serum testosterone level returned to normal after surgery (8.2 ng/dL [0.3 nmol/L]). (Reprinted, with permission, from reference 36.)
