Ovarian steroid cell tumor, not otherwise specified: A rare case of postmenopausal vaginal bleeding

Abstract

Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS) are particularly rare ovarian tumors, which are composed of steroid-hormone secreting cells. The majority of patients with this tumor produce excessive quantities of testosterone and virilization is common. The current report presents a rare case of SCT in a 59-year-old female who presented with postmenopausal vaginal bleeding. The patient had experienced irregular vaginal bleeding for two months, 12 years after menopause. Transvaginal ultrasound and magnetic resonance imaging identified a solid adnexal mass and the pathological result of diagnostic curettage showed a proliferative endometrium. The patient’s serum estrogen and testosterone levels were elevated (393.71 nmol/l and 22.28 nmol/l, respectively). The patient underwent an exploratory laparotomy, hysterectomy and bisalpingectomy. The neoplasm was well-circumscribed, solid, homogeneous and yellow in color. Microscopically, the tumor was predominantly composed of granular eosinophilic or vacuolated cytoplasm. Reinke’s crystals, prominent nucleoli and Call-Exner bodies were not observed, and there was no mitotic figure. Immunohistochemistry demonstrated that the tumor cells were strongly positive for inhibin. The present rare case aims to expand the current knowledge of this type of ovarian tumor.

Ovarian Steroid Cell Tumor Associated to Endometrial Hyperplasia and Presenting as Postmenopausal Vaginal Bleeding

“…During reproductive age, the typical presentation is virilization (hirsutism, hair loss, amenorrhea or oligomenorrhea), although 10 to 25% of SCT NOS do not produce any hormones or symptoms [3,15,16]. Hirsutism and abrupt cessation of cyclic menses usually appear at the same time.…”

“…The mean age of diagnosis is 58 years for stromal luteomas and Leydig cell tumors [2], and usually affects younger women for adrenal cortical SCT [2,[8][9][10] and SCT NOS [2,11]. Adrenal-cortical and SCT NOS can present prior to puberty [2,3,8,11], and have even been described in fetuses [12]. In prepuberal girls it can cause isosexual precocity [13,14], with hirsutism, acne, growth-acceleration, clitoral enlargement and pubic hair.…”

“…They account for 7% of all ovarian neoplasms. Sex-cord stromal tumors only represent 6% of them (less than 0.1% of all ovarian tumors) [1][2][3].…”

Ovarian steroid cell tumor, not otherwise specified: A case report and literature review

“…To date, 24 cases of ovarian SCT in young female patients aged 2.5-13 years have been reported, but none have been malignant (6,(8)(9)(10)(11). Therefore, ovarian masses suspicious for SCT in children at an early stage should be approached conservatively, unless distinct signs of metastasis are present at the time of surgery (12). Immunohistochemistry is particularly useful for the accurate diagnosis of SCTs.…”

“…In our patient, although the diameter of the mass was >7 cm, we opted for right salpingo-oophorectomy as the tumor was stage Ⅰa. It is also necessary to monitor the patient's hormone levels as part of their postoperative follow-up (12).…”