Magnetic resonance imaging findings of ovarian stromal hyperthecosis

Fujii, Shinya; Kiyokawa, Takako; Tsukihara, Satoru; Senda, Tomoko; Tahara, Tetsuya; Kaminou, Toshio; Ogawa, Toshihide

doi:10.1080/02841850903207188

Cited by 6 publications

(3 citation statements)

References 5 publications

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“…The first MRI case report described symmetric ovarian enlargement, homogeneous T2 hypointensity, and mild enhancement post contrast [17]. One other case report described bilateral ovarian masses that showed isointensity to myometrium on both T1 and T2 weighted sequences [18]. This patient's differential diagnosis as suggested by her MRI findings includes ovarian fibromas, however, in this entity, there is partial sparing of the ovaries with visualization of the follicles and a thick rind of hypointense tissue [17,19,20].…”

Section: Discussionmentioning

confidence: 98%

Ovarian Stromal Hyperthecosis and Hyperandrogenemia Refractory to Hormonal Suppression

Gressel¹

2015

Obstet Gynecol Cases Rev

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been menopausal since age 53 and for approximately 1 year, had noted undesired increased libido and hirsutism. Although she was not sexually active with her husband, she experienced frequent and unprovoked spontaneous orgasms. She also reported hair growth on her arms, shoulders, chin and upper lip as well as recession of her hairline and thinning of hair on her scalp. The patient's medical history was remarkable for recently diagnosed subclinical hyperthyroidism, osteoporosis, obesity, as well as Meniere's disease, hypertension and chronic obstructive pulmonary disease. She also had a long-standing history of type 2 diabetes mellitus on oral hypoglycemics with a baseline hemoglobin A1C value of 6.2%. Her obstetrical history was significant for 2 terms, uncomplicated vaginal deliveries. Her gynecologic history included late onset of menarche at the age of 16 and a history of life-long oligomenorrhea. Other than a twenty-pack year smoking history, she reported no other significant medical comorbidities.On evaluation, the patient was noted to have normal vital signs with a body mass index of 36.6 kg/m 2 . She appeared hirsute with facial and lower abdominal hair growth as well as male pattern alopecia. She also exhibited cervicodorsal protuberance ("buffalo hump") and clitoromegaly, above the upper limit for her age. Laboratory assessment demonstrated elevated free (12.0 pg/mL) and total (115 ng/dL) testosterone, but normal 17-hydroxyprogesterone (39 ng/dL), dehydroepiandrosterone (57 mcg/dL), and its sulfate (36 mcg/dL). Prolactin (10.6 ng/mL), estradiol (18 pg/mL), luteinizing hormone (43.1 mIU/mL) and follicular stimulating hormone (48.5 mIU/mL) were all within normal limits for a postmenopausal woman. Thyroid stimulating hormone levels were very low (< 0.005 uU/mL), and the patient was started on methimazole for hyperthyroidism. Additional laboratory values,such as glucose tolerance testing and insulin levels, were unavailable. The patient's workup included a transvaginal ultrasound demonstrating a uterus measuring 3.7 × 6.4 × 4.7 cm, with right ovary measuring 1.74 × 2.27 × 2.42 cm and her left ovary measuring 1.89 × 2.26 × 2.24 cm. Given the increased ovarian volume for a postmenopausal woman (normal postmenopausal average volume of

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Section: Discussionmentioning

confidence: 98%

Ovarian Stromal Hyperthecosis and Hyperandrogenemia Refractory to Hormonal Suppression

Gressel¹

2015

Obstet Gynecol Cases Rev

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“…Stromal hyperplasia is characterized by a diffuse or nodular non-neoplastic proliferation of plum ovarian cortical stromal cell encroaching upon the medulla. [8] Stromal hyperplasia is seen most commonly in postmenopausal patients and may be associated with raised androgen levels and also with endometrial adenocarcinoma. Stromal hyperplasia is quite often bilateral, and may be associated with normal sized or enlarged ovaries.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of ovarian lesions inducing endometrial hyperplasia or carcinoma in a tertiary care hospital in Southern India

Rao

Lall³

et al. 2013

J Basic Clin Reprod Sci

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Background: Excessive and prolonged estrogenic stimulation results in endometrial hyperplasias or endometrioid adenocarcinomas. One of the major reasons for an excess endogenous estrogen production is estrogen secreting ovarian lesions which could either be neoplastic or non-neoplastic. Aims: This was a study done to evaluate and correlate presence of ovarian lesions in uterus harboring endometrial hyperplasia or endometrial carcinoma. Materials and Methods: This was a retrospective study conducted at a referral hospital in South India over a 16-year period. Histology of ovaries were studied in panhysterectomy cases with a tissue diagnosis of endometrial hyperplasia or endometrial carcinoma. The data was evaluated as only percentage. Results: A total of 118 specimens revealed pathological proliferative lesion of the endometrium with endometrial hyperplasias occurring in 78 (66.1%) and endometrioid adenocarcinoma in the remaining 40 (33.9%) cases. Fifty-two cases showed lesions in ovary/ovaries. Forty-two (35.6%) of them revealed estrogen-secreting lesions in ovaries. The rest showed non-estrogen producing lesions. Follicular cyst was the predominant estrogen elaborating lesions in the ovary with 23 cases (44.2%). In 21.1% of cases, ovaries featured stromal hyperplasia and 7.7% showed granulosa cell tumor. Only one (1.9%) case of thecoma was identifi ed. Two cases showed twin lesions with follicular cyst and stromal hyperplasia. All patients except for one were in post-menopausal age group. Conclusion: Follicular cyst was the predominant lesion associated with endometrial hyperplasia and endometrioid adenocarcinoma of endometrium in post-menopausal age group. In addition, hyperplastic lesions in endometrium can occur in non-hormonal secreting ovarian epithelial tumors possibly due to functioning stromal cells.

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“…A solid mass may also be seen infrequently, due to a ''nodular'' form or a coexisting fibrothecoma [30]. The periphery of the ovarian masses appears T 1 and T 2 isointense (to myometrium), which is described as characteristic of stromal hyperthecosis [36]. In contrast to PCOS, SH is not accompanied by altered serum LH:FSH levels and rarely responds to an oral contraceptive regimen alone.…”

Section: Stromal Hyperthecosismentioning

confidence: 99%