Ovarian steroid cell tumor and a contralateral ovarian thecoma in a postmenopausal woman with severe hyperandrogenism.
A 49-year-old woman presented with rapidly progressing hirsutism, receding hairline, male-pattern baldness and deepening of voice, which had developed over the past 2 years. Hormonal evaluation showed a markedly elevated serum testosterone level (418 ng/dl) and no evidence of increased production of cortisol, dehydroepiandrosterone, dehydroepiadrosterone-sulfate, androstenedione, or 17-hydroxyprogesterone. Transvaginal ultrasound examination suggested the presence of a small mass within the left ovary, but all other radiological studies, including adrenal and ovarian computed tomography, magnetic resonance imaging, radio-labelled cholesterol scintigraphy and positron emission tomography, were negative. Subsequently, bilateral selective venous sampling showed a marked testosterone gradient in the right ovarian vein. Bilateral salpingo-oophorectomy was performed (the patient had had a previous vaginal hysterectomy), and histopathological examination revealed a 10-mm steroid cell tumor within the right ovary and a 15-mm thecal cell tumor within the left ovary. The postoperative serum testosterone level returned to normal and the patient showed a slow regression of clinical symptoms. The simultaneous occurrence of a virilizing ovarian steroid cell tumor and an apparently non-functioning thecoma within the contralateral ovary emphasizes the potential pitfalls that may exist in the preoperative evaluation of patients with markedly increased testosterone production.
Cserepes
E
E
Department of Radiology, Faculty of Health Sciences, Semmelweis University, Budapest, Hungary.
Szücs
N
N
Patkós
P
P
Csapó
Z
Z
Molnár
F
F
Tóth
M
M
Dabasi
G
G
Esik
O
O
Rácz
K
K
D000505:Alopecia / Q000209:etiology / Q000473:pathology; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D017588:Hyperandrogenism / Q000209:etiology* / Q000473:pathology; D007984:Leydig Cell Tumor / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D012489:Salpingostomy; D013739:Testosterone / Q000097:blood; D013798:Thecoma / Q000150:complications / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery; D014770:Virilism / Q000209:etiology / Q000473:pathology
D013739:Testosterone