Introduction/Background Sertoli-Leydig tumors are hormone-secreting tumors, which belong to the group of stromal tumors and sex cords; they are very rare, it accounts for less than 0.2% of all ovarian tumors; they are most often responsible for virilization syndrome.

Methodology we report the case of a 57-year-old woman who presented with postmenopausal virilism for 2 years revealing a well-differentiated Sertoli-Leydig cell tumor of the ovary.

Results A 57-year-old patient, with a history of type 2 diabetes, arterial hypertension, hypothyroidism. The history of the disease was marked by the progressive installation of signs of virilization (hirsutism, hoarseness, hypertricosis, hair loss). a high level of testosterone was found. The scanner showed a hypodense formation at the level of the right ovary of 24 mm. The patient was discharged under cyproterone acetate, with clinical and biological monitoring. Four years later, she was rehospitalized in the face of the persistence of signs of virilism. She presented an abnormal hair distribution (severe hirsutism with Ferriman and Gallway SCORE over 25). Gynecological examination showed an enlarged clitoris, atrophy of the vaginal mucosa, the cervix was healthy. The intravaginal ultrasound was without abnormality. The patient underwent laparoscopic surgery. Intraoperatively, the ovaries were small, without mass, the uterus and fallopian tubes were without abnormality, there was no peritoneal carcinomatosis. A bilateral adnexectomy was performed. Clinical improvement of the signs of virilization was noticed 3 weeks later. The histological examination of the specimen revealed a hilar Leydig cell tumor that measured 8 mm in its largest axis

Conclusion stromal tumor and sex cords are very rare, sertoli-leydig cell tumors are the most. The differentiated forms have a low potential for malignancy, the treatment is surgical, the prognosis after surgery is good.