The detection of
testosterone-producing ovarian
tumors in childhood and adolescence by imaging techniques only can be difficult because of the
tumors' radiological structure and sometimes diminutive size. We describe an 11.5-year-old girl with a 9-month history of voice deepening, mild
hirsutism, minor
acne, increased growth velocity,
weight gain, and clitoromegaly. Laboratory investigation revealed an extremely elevated serum
testosterone level without any additional endocrine abnormalities. Abdominal ultrasound and MRI showed a sparsely noticeable solid mass in the center of the right ovary. At
laparotomy, blood was selectively drawn from the right and the left ovarian veins. Rapid
testosterone measurement revealed a 70-fold higher
testosterone concentration in the right ovarian vein within 45 min. Based on this finding, a right
salpingo-oophorectomy was performed. The patient's postoperative
testosterone level declined within 24 h. The histopathological diagnosis was
Leydig cell tumor. In conclusion, the implementation of a fast intraoperative
testosterone assay enabled the localization and curative
therapy of a
Leydig cell tumor. This technique seems to be a good alternative to preoperative selective venous blood sampling when body imaging does not unveil the
tumor's site.