Ovarian steroid cell tumor as an example of severe hyperandrogenism in 45-year-old woman

Abstract

Approximately, 5% of ovarian tumors have hormonal activity. Steroid cell tumors (SCTs) represent about 0.1% of all ovarian tumors. They cause hyperandrogenism associated with typical virilization. In this case report, we present 45-year-old women with unmalignant ovarian SCT-producing androgens which cause severe virilization and secondary amenorrhea lasting two years. Transvaginal ultrasound, computed tomography of adrenal glands, magnetic resonance imaging of small pelvis, laboratory tests (including serum concentration of FSH, LH, testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), as well as ROMA index) were performed. During hormonal evaluation, elevated concentrations of serum T – on admission 1.72 ng/ml and one month later 3.75 ng/ml (normal range 0.08–0.82 ng/ml) and A – 24.90 ng/ml (normal range 0.40–3.40 ng/ml) were found. The ROMA index was within the normal range. Enlargement of the left ovary by solid mass 56 × 43 mm was found during ultrasound examination. Based on small pelvis MRI scan and hormonal finding, patient was qualified for laparotomy. During this procedure, the left salpingo-oophorectomy with removal of the tumor was performed. The histopathological examination identified SCT. During follow-up examination, one day after surgery, we found serum testosterone levels within normal ranges – 0.74 ng/ml (normal range 0.08–0.82 ng/ml). This case shows that hormone-producing ovarian tumors are rare but very important clinical causes of severe hyperandrogenism.

摘要

约有5% 的卵巢肿瘤具有激素活性。类固醇细胞瘤 (SCTs) 约占所有卵巢肿瘤的0.1%。它们引起与典型男性化相关的高雄激素血症。在本病例中, 我们报告了一位45岁的女性, 患有良性卵巢SCT产生的雄激素, 导致严重的男性化和继发性闭经持续两年。进行了经阴道超声, 肾上腺计算机断层扫描, 小骨盆磁共振成像, 实验室检查 (包括血清FSH, LH, 睾酮 (T), 雄烯二酮 (A), 硫酸脱氢表雄酮 (DHEA-S) 以及ROMA指数)。激素检查发现入院时血清T - 浓度为1.72 ng/ml, 一个月后升高为3.75 ng/ml (正常范围0.08-0.82 ng/ml), A - 24.90 ng/ml (正常范围0.40-3.40 ng/ml)。ROMA指数在正常范围内。超声检查发现左卵巢实性肿块增大为56 × 43 mm。根据小骨盆MRI扫描和激素检查, 该患者符合剖腹手术的指征。在手术过程中, 进行了左卵巢输卵管卵巢切除术并肿瘤切除术。组织病理学检查证实为SCT。在术后第一天的随访检查中, 我们发现血清睾酮水平在正常范围内 - 0.74 ng/ml (正常范围为0.08-0.82 ng/ml)。该病例表明, 产生激素的卵巢肿瘤是严重高雄激素血症的罕见但非常重要的临床原因。

The Chinese abstracts are translated by Prof. Dr. Xiangyan Ruan and her team: Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing 100026, China.

Keywords:

• Steroid cell tumor
• hyperandrogenism
• hirsutism
• ovarian tumor

Disclosure statement

The authors report no conflicts of interest.