Leydig cell tumour and mature ovarian teratoma: rare androgen-secreting ovarian tumours in postmenopausal women

Abstract

Androgen-secreting ovarian tumours are extremely rare accounting for <5% of all ovarian neoplasms. They are more frequent in postmenopausal women and should be suspected in the case of a rapid onset of androgenic symptoms. We report 4 cases of postmenopausal women who presented with signs of virilisation. All patients revealed increased serum levels of testosterone, normal dehydroepiandrosterone-sulfate and negative pelvic ultrasound for adnexal masses. An androgen-secreting ovarian tumour was suspected and all of them were submitted to bilateral oophorectomy. Histology confirmed the diagnosis of Leydig cell tumours in 3 patients and mature teratoma in 1. A successful response to surgery, which includes a decline in serum androgen levels and signs of hyperandrogenism, was observed in our patients. This case series demonstrates that androgen-secreting ovarian neoplasms may not be detectable by imaging studies, but should be considered in the differential diagnosis of all postmenopausal women with signs of hyperandrogenism.

Virilization Secondary to Androgen-Secreting Tumor of the Ovary: A Report of Three Cases and Review of Literature

“…In patients with raised 17-OHP, as was seen in Case 2, the diagnosis of CAH has to be confirmed by measuring the 17-OHP concentration 1 h after stimulation with intravenous ACTH. A value of \ 10 ng/ml rules out lateonset CAH [1].…”

“…The sonographic appearance varies from small to large, solid to cystic masses, depending upon the histologic subtype. MRI provides further description of these tumors and provides additional information regarding presence or absence of adrenal mass, lymphadenopathy and/or ascites [1].…”

“…Androgen-secreting tumors of the ovary represent \ 5% of all ovarian tumors and are a rare cause (0.2% of cases) of androgen excess in females. They belong to the category of sex-cord stromal tumors; the most commonly implicated are Sertoli-Leydig cell tumors (SLCTs), Leydig cell tumors, steroid cell tumors, fibrothecomas and rarely granulosa cell tumors [1,2]. Owing to their rarity, there is limited understanding of their natural progression and optimal management strategies.…”

Incidental finding of a Sertoli-Leydig cell tumor in a postmenopausal woman with complex endometrial hyperplasia

“…7 Radiologic studies such as pelvic ultrasonography and computerized tomography (CT) are not the recommended definitive means of diagnosis due to is lack of accuracy in diagnosing the SLCTs. 8 This is a unique case of an incidental SLCT where neither clinical symptom such as virilization nor radiologic findings such as adnexal mass were noted prior to the surgery. Sertoli cells are known to secrete estrogens resulting in hyperestrogenism, but it remains a question whether or not the endometrial hyperplasia in this case has resulted from hyperestrogenism released from the SLCT of the ovary.…”

An Ovarian Leydig Cell Tumour in a Postmenopausal Woman that was Missed on an Ultrasonogram: A Case Report

“…However, postoperative pathology confirmed bilateral proliferation of ovarian Leydig cells. Palha [14] believes that because LCTs are extremely small, these ovarian tumours lack typical imaging features and there is a lack of diagnostic consistency between imaging and histology. Of the 3 cases of LCT she discussed (all of which involved tumours smaller than 3 cm), 2 cases included negative ultrasound and CT results.…”