Ovarian Leydig cell tumor in a post-menopausal patient with severe hyperandrogenism

Abstract

Leydig cell tumors are rare ovarian steroid cell neoplasms. More than 75% of patients show signs of virilization due to overproduction of testosterone. We report a case of an 8-year-old woman with progressive signs of virilization, and presenting vaginal bleeding. Clinical analyses revealed high levels of serum testosterone, delta 4-androstenedione and estradiol, and also inappropriate low levels of gonadotrophins for a post-menopausal woman. Transvaginal ultrasound showed no evidence of ovarian tumor, but pelvic and abdominal computerized axial tomography imaging revealed a left ovarian solid nodule, and no evidence of alteration in the adrenal glands. Total hysterectomy and bilateral salpingoophorectomy were performed. Histopathology and immunohistochemistry confirmed the diagnosis of Leydig cell tumor. After surgery, androgen levels returned to normal, and there was regression of the signs of virilization.

Sex cord-stromal tumors of the ovary: a comprehensive review and update for radiologists

“…Leydig tumors tend to be small (mean, 2.4 cm) and are reportedly isoechoic to the uterus on US and hypoattenuating on CT (5,27,28). The signal intensity on T2-weighted imaging differs depending on the amount of fibrous stroma (10,28).…”

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

“…A Leydig stromal cell tumour is a rare ovarian tumour that belongs to the group of sex-cord stromal tumours and accounts for <0.1% of all ovarian tumours 1 3. More than 75% of patients show signs of virilisation, resulting from autonomous androgen secretion.…”

“…Androgen-secreting neoplasms of the ovary are a rare cause of hyperandrogenism in women and account for <5% of all ovarian neoplasms 1. Hyperandrogenism can result in a virilisation syndrome, which is characterised by clitoral hypertrophy, deepening of the voice, increased libido, breast atrophy, severe hirsutism and male-pattern baldness 1 2.…”

“…Hyperandrogenism can result in a virilisation syndrome, which is characterised by clitoral hypertrophy, deepening of the voice, increased libido, breast atrophy, severe hirsutism and male-pattern baldness 1 2. These tumours should be suspected when the onset of androgenic symptoms is sudden and rapidly progressive,3 especially if associated with signs of virilisation or defeminisation.…”

“…According to the WHO, Leydig cell tumours are classified in this group and account for 0.1% of all ovarian tumours 1 4…”