A large ovarian steroid cell tumor‐not otherwise specified with a unique combination of benign and malignant features as a challenging cause of oligomenorrhea and hirsutism in a 21‐year‐old Syrian female: a case report

Abstract

Background Ovarian steroid cell tumors represent a rare category of sex cord-stromal tumors that constitute less than 0.1% of all ovarian tumors. These neoplasms are classified into three main subtypes according to the cell of origin: Leidyg cell tumors, stromal luteomas, and steroid cell tumors not otherwise specified (SCTs-NOS). The latter subtype is defined as a neoplasm of an uncertain lineage that mostly affects middle-aged women, whereas it’s rare in younger ages. Case presentation We report a case of a 21-year-old virgin female who presented to our hospital with complaints of mild abdominal pain, hirsutism, and oligomenorrhea for more than a year. Before her current admission, the patient had attended an external gynecologic clinic where she had been prescribed oral contraceptives to regulate her periods. Nevertheless, on presentation to our institution, physical examination revealed abdominal tenderness with a palpable pelvic mass and mild hirsutism in the thigh. Ultrasonography demonstrated a large left ovarian mass measuring 154 × 104 mm, and compressing the uterus. Therefore, a unilateral salpingo-oophorectomy was performed, and interestingly, pathologic examination of the large aforementioned mass alongside with immunohistochemical correlation revealed the diagnosis of a large ovarian steroid cell tumor-not otherwise specified with a unique combination of benign and malignant features. Conclusions Although ovarian steroid cell tumors represent a rare category, they must be considered in the differential diagnosis for mild virilization symptoms in young females due to the importance of early diagnosis and management. In this manuscript, we aimed to present the first case report from Syria that highlights the crucial role of detailed morphological examination for challenging cases despite the difficulties in differential diagnosis, and the absence of ancillary techniques. Furthermore, we managed to discuss a brief review of diagnostic methods, histological characteristics, and treatment recommendations.

Ovarian mass in a patient with invasive breast carcinoma: A case report of an unexpected diagnosis

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A Virilizing Malignant Steroid Cell Tumor-Leydig Cell Subtype in a 24-Year-Old Palestinian Female with Challenging Histopathological and Biochemical Features: A Case Report

“…The presence of crystals of Reinke is helpful to distinguish LCT from SCT-NOS, which are not accompanied by Leydig cell hyperplasia. The absence of spindle cells and bromatous background is useful to distinguish it from luteinized thecoma (12). General immunohistochemistry observations might be useful in problematic case, CD99 for example, is expressed in all sex cord stromal tumors except for SCT-NOS and broma, inhibin and calretinin are expressed less with bromas.…”

Hirsutism as the initial presentation of malignant ovarian Leydig cell tumor: A case report

“…The presence of crystals of Reinke is helpful to distinguish LCT from SCT‐NOS, the last is not accompanied by Leydig cell hyperplasia. The absence of spindle cells and fibromatous background is useful to distinguish SCT from luteinized thecoma 12 . General immunohistochemistry observations might be useful in problematic cases; for example, CD99 is expressed in all sex cord stromal tumors except for SCT‐NOS and fibromas.…”