Ovarian steroid cell tumor and a contralateral ovarian thecoma in a postmenopausal woman with severe hyperandrogenism.

Abstract

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.

• Authors: E Cserepes, N Szücs, P Patkós, Z Csapó, F Molnár, M Tóth, G Dabasi, O Esik, K Rácz
• Journal: Gynecological endocrinology : the official journal of the International Society of Gynecological Endocrinology (Gynecol Endocrinol) Vol. 16 Issue 3 Pg. 213-6 (Jun 2002) ISSN: 0951-3590 [Print] England
• PMID: 12192893 (Publication Type: Case Reports, Journal Article)

Chemical References

• Testosterone

Topics

• Alopecia (etiology, pathology)
• Diagnosis, Differential
• Female
• Humans
• Hyperandrogenism (etiology, pathology)
• Leydig Cell Tumor (complications, diagnosis, pathology, surgery)
• Middle Aged
• Neoplasms, Multiple Primary (complications, diagnosis, pathology, surgery)
• Ovarian Neoplasms (complications, diagnosis, pathology, surgery)
• Ovariectomy
• Salpingostomy
• Testosterone (blood)
• Thecoma (complications, diagnosis, pathology, surgery)
• Virilism (etiology, pathology)