Sertoli-Leydig cell tumor in a 22-year-old woman with irregular menses and abdominal swelling. Sagittal T2-weighted image demonstrates a huge multilocular cystic mass with solid area and mural nodules (white arrow), which are the moderate signal intensity (A) and enhanced intensely after the administration of contrast medium (B). (C) Grossly, the tumor shows an encapsulated cystic mass (fluid has been removed) with reddish solid area and yellowish nodules (black arrow). (D) Microscopically, Leydig cells (arrowhead) are sparse in the background of Sertoli cells, which arrange in closed tubules (black arrow). The sertoli cells have abundant vacuolated cytoplasm filled with lipid (H&E×400). (E) The sex cord areas stain strongly for α-inhibin (α-inhibin stain ×200).