Diagnosis of an indistinct Leydig cell tumor by positron emission tomography-computed tomography

Abstract

A 51-year-old perimenopausal female patient presented with hirsutism and voice thickening which was started approximately one and a half years ago. Her initial hormone assay revealed elevated plasma testosterone, 5a-dihydrotestosterone, and dehydroepiandrosterone (DHEA) levels and therefore androgen-secreting tumor was first suspected. However, the lesion was inconspicuous on transvaginal sonography, abdominal-pelvic computed tomography (CT) scan, and pelvic magnetic resonance (MRI) imaging. Consequently, 18 F-fluorodeoxyglucose (FDG) positron emission tomography-CT was performed, which localized the lesion as a focal FDG uptake within the right adnexa. Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy was performed, and although visible gross mass lesions were not observed intraoperatively, pure Leydig cell tumor was pathologically confirmed within the right ovary. Plasma testosterone, 5a-dihydrotestosterone, and DHEA levels were normalized postoperatively. Clinical signs of virilization were also significantly resolved after 3-months of follow-up.

The Hidden Source of Testosterone Hypersecretion in a Female—A 30-Year Journey

“…A case resembling ours was also documented by Kong et al ( 11 ). In their report, a 51-year-old woman presented with signs and symptoms of hyperandrogenism persisting for 18 months, raising concerns about the presence of an androgen-producing tumor.…”

“…It can be challenging to confirm the presence of a small ovarian tumor with conventional imaging modalities, despite the clear suggestion from the biochemical findings. Both CT and MRI could be inadequate imaging modalities for a small ovarian tumor, as reported by Kong et al ( 11 ). In both our case and the one reported by Kong et al, small Leydig cell tumors, each measuring less than 2 cm in diameter, were ultimately diagnosed ( 11 ).…”

“…Both CT and MRI could be inadequate imaging modalities for a small ovarian tumor, as reported by Kong et al ( 11 ). In both our case and the one reported by Kong et al, small Leydig cell tumors, each measuring less than 2 cm in diameter, were ultimately diagnosed ( 11 ). Our patient and the 2 other published case reports demonstrated the utility of PET/CT scans in detecting small SLCTs in the ovary ( 11 , 12 ).…”

Bilateral Ovarian Leydig Cell Tumors in a Postmenopausal Woman Causing Hirsutism and Virilization

“…Additional available imaging procedures include ovarian vein sampling for testosterone and positron emission tomography. 10 , 11 We did not perform these imaging procedures in our patient, although a positron emission tomography scan may have been useful. Thus, with a preoperative diagnosis of ovarian hyperthecosis, the patient underwent laparoscopic bilateral oophorectomy.…”

Detection of pure Leydig cell ovarian tumor not visible on imaging by selective venous blood sampling in a woman with secondary amenorrhea and hirsutism: A case report

“…Conventional imaging studies such as ultrasonography, computed tomography, and magnetic resonance imaging can usually localize a hormone-producing tumor when it reaches a sufficient size. Furthermore, there have been reports on the usefulness of transvaginal color Doppler ultrasonography [ 8 ] and positron emission tomography CT [ 9 ]. However, some tumors are too small to detect, so making the differential diagnosis difficult before surgical exploration.…”