title: Virilising ovarian tumour: a case associating a Sertoli-Leydig cell tumour and a Brenner tumour.
abstract: Ovarian Sertoli-Leydig cell tumours (SLCT), also termed arrhenoblastomas, are the most frequent virilising tumours in women of reproductive age. Very rare secretory Brenner tumours (BT) have been described, generally after the menopause. A 31-year-old woman sought medical advice for secondary amenorrhoea, progressive hirsutism and a 5-year history of virilisation syndrome with clitoromegaly. Testosterone was markedly high (285 ng/dl, N<85) with moderate elevation of delta 4-androstenedione (D4AD) (311 ng/dl, N <270), dehydroepiandrosterone sulfate (DHEAS) (366 μg/dl, N <340) and 17-hydroxyprogesterone (17OHP) (275 ng/dl). LH was 9 IU/l, FSH 4.3 IU/l, estradiol 60 pg/ml and progesterone 314 ng/100 ml. Cortisol was decreased (1.3 μg/dl) after the dexamethasone suppression test. Pelvic MRI showed a 5-cm right ovarian tumour with a 2.5 cm nodular component and cystic areas, and two nodules measuring 11 mm and 15 mm above the right and left ovaries. After right ovariectomy by laparoscopy, pathological examination concluded on a 3-cm SLCT and a 2-cm BT; the nodules above the ovaries were dysembryoplastic cysts. Postoperatively, testosterone level was normal after 24 h (26 ng/dl), estradiol and progesterone rapidly decreased, cyclic secretion then resumed and the patient menstruated at day 27. To our knowledge, this is the first report of an ovarian tumour associating a Sertoli-Leydig cell tumour and a Brenner tumour in a patient with virilisation syndrome which resolved after ovariectomy.
authors.affiliation: Service d'Endocrinologie et Maladies Métaboliques, Centre Hospitalier Universitaire Larrey, Toulouse, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Persechini
authors.forename: Stephanie
authors.initials: S
authors.lastname: Motton
authors.forename: Pierre
authors.initials: P
authors.lastname: Leguevaque
authors.forename: Florence
authors.initials: F
authors.lastname: Donadille
authors.forename: Ghislaine
authors.initials: G
authors.lastname: Escourrou
authors.forename: Bogdan
authors.initials: B
authors.lastname: Vierasu
authors.forename: Safouane
authors.initials: S
authors.lastname: Hamdi
authors.forename: Antoine
authors.initials: A
authors.lastname: Bennet
authors.forename: Philippe
authors.initials: P
authors.lastname: Caron
mesh_terms: D019326:17-alpha-Hydroxyprogesterone / Q000097:blood; D000328:Adult; D000568:Amenorrhea / Q000209:etiology; D000735:Androstenedione / Q000097:blood; D001948:Brenner Tumor / Q000150:complications* / Q000473:pathology / Q000601:surgery; D002987:Clitoris / Q000503:physiopathology; D019314:Dehydroepiandrosterone Sulfate / Q000097:blood; D005260:Female; D006628:Hirsutism / Q000209:etiology; D006801:Humans; D010051:Ovarian Neoplasms / Q000150:complications* / Q000473:pathology / Q000601:surgery; D010052:Ovariectomy; D018310:Sertoli-Leydig Cell Tumor / Q000150:complications / Q000473:pathology / Q000601:surgery; D013739:Testosterone / Q000097:blood; D016896:Treatment Outcome; D014770:Virilism / Q000209:etiology*
chemical_list: D013739:Testosterone; D000735:Androstenedione; D019314:Dehydroepiandrosterone Sulfate; D019326:17-alpha-Hydroxyprogesterone