Ovarian Stromal Hyperplasia: A Rare Cause of Postmenopausal Hyperandrogenism

Araque, Teresa Lozoya; Monfort-Ortíz, Rogelio; González, José Enrique Martín; García, Alenda Jiménez; Hidalgo, Inmaculada Navarro; Gamarra, Verónica Andrade; Soler, Cecilia Parrell; Raga, Fernando Gil

doi:10.6118/jmm.19012

Cited by 8 publications

(7 citation statements)

References 14 publications

(23 reference statements)

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“…2 Management of hyperthecosis is usually bilateral salpingo-oophorectomy. 3 But fortunately, on referral of the case to gynaecology, two malignancies in their early stage could be diagnosed. Considering the microscopic nature of the malignancies, no further treatment was required.…”

Section: Discussionmentioning

confidence: 99%

“…2 Among the ovarian causes in postmenopausal women, ovarian virilizing tumours and hyperthecosis of the ovarian stroma are most common. 3 Stromal hyperthecosis occurs in one third of postmenopausal patients usually as an incidental finding. 4 The luteinized cells in this condition give rise to excess androgen production.…”

Section: Introductionmentioning

confidence: 99%

“…2 Among the ovarian causes in postmenopausal women, ovarian virilizing tumours and hyperthecosis of the ovarian stroma are most common. 3…”

Section: Introductionmentioning

confidence: 99%

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How hairfall saved the patient from cancer twice – A postmenopausal patient with synchronous endometrial and endocervical carcinomas presenting with endocrine symptoms

et al. 2023

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Ovarian stromal hyperthecosis is an uncommon nonneoplastic cause of ovarian hyperandrogenism mainly in postmenopausal women. Here, we present a case of a postmenopausal woman who presented with features of virilization like alopecia and hirsutism. During its workup, two malignancies were diagnosed at a very early stage. Microscopic focus of endometrial adenocarcinoma in a polyp and similar focus of endocervical adenocarcinoma in the subsequent hysterectomy specimen were noted. Presence of synchronous malignancies in the uterus is very rare and it being detected in a patient who presented with a non-related symptom of hairfall makes it an interesting case scenario.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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How hairfall saved the patient from cancer twice – A postmenopausal patient with synchronous endometrial and endocervical carcinomas presenting with endocrine symptoms

et al. 2023

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“…Ovarian stromal hyperplasia is another rare histological finding and is associated with hyperandrogenism, obesity, hyperinsulinaemia and acanthosis nigricans in postmenopausal women 18 19. In menopause, the concentrations of circulating androgens decrease.…”

Section: Discussionmentioning

confidence: 99%

Rare case of coexisting ovarian Brenner tumour and ovarian stromal hyperplasia presenting with persistent endometrial hyperplasia following treatment with levonorgestrel-intrauterine system

Mok

Chin

2022

BMJ Case Rep

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Endometrial hyperplasia (EH) is a precursor of endometrial cancer. It arises in an environment of unopposed oestrogen. Treatment is based on a combination of weight management, diet and exercise, and the use of progestogens either via a levonogestrel-intrauterine system (LNG-IUS) or orally. The LNG-IUS is the first-line recommendation for EH without atypia. Recurrences are rare, and any recurrences despite prolonged treatment and control of risk factors necessitate a thorough consideration of other oestrogenic sources. This case report presents a rare case of a coexisting ovarian Brenner tumour and ovarian stromal hyperplasia in a menopausal patient in her 50s with recurrent EH despite earlier regression. The above histology may have provided the additional oestrogenic influence. This patient subsequently underwent a definitive hysterectomy and bilateral salpingo-oophorectomy (BSO). It is important to maintain a high index of suspicion for potential oestrogenic influences in cases of refractory EH that are not identifiable on imaging. BSO should be considered at the time of hysterectomy in such cases of unidentified oestrogenic foci.

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“…La hiperplasia del estroma ovárico y la hipertecosis ovárica son afecciones poco comunes que suelen afectar a mujeres posmenopáusicas y raramente en la premenopausia. A nivel histológico, la hiperplasia estromal se caracteriza por una proliferación nodular o difusa del estroma ovárico, mientras que la hipertecosis implica una proliferación no neoplásica del estroma acompañada de células estromales luteinizadas 5 . Las células de la hipertecosis expresan proteínas de adhesión celular (Bcl-2) que le confieren resistencia a la apoptosis, no así las células de la hiperplasia estromal que son negativas para este marcador 6 .…”

Section: Discussionunclassified

Virilización y enfermedad metabólica en mujer postmenopáusica relacionado a hiperplasia e hipertecosis ovárica

Larrea¹,

González²,

Knoblovits³

et al. 2021

Rev Fac Cien Med Univ Nac Cordoba

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Durante la transición menopáusica pueden aparecer signos clínicos leves de hiperandrogenismo, como parte del proceso de envejecimiento normal, pero el desarrollo de virilización franca sugiere una fuente específica de exceso de andrógenos debiendo descartar la presencia de tumores secretores de andrógenos tanto a nivel adrenal como ovárico. Se presenta un caso de una mujer de 51 años postmenopáusica con signos de virilización de 12 meses de evolución, asociado a antecedente personal de diabetes tipo 2 e hipertensión arterial, de mal manejo en el último año. Las pruebas de laboratorio mostraron una franca elevación de los niveles de andrógeno sérico e hiperinsulinemia asociada. Las imágenes solicitadas evidenciaron ambos ovarios aumentados de tamaño de aspecto homogéneo y sólido, con glándulas adrenales de aspecto conservado, lo que hizo sospechar de una posible hiperplasia tecal del estroma ovárico. Se realizó una anexectomía bilateral por laparoscopia, cuya anatomía patológica confirmó la presunción diagnóstica. Los dosajes de testosterona sérica al mes de la cirugía retornaron a valores cercanos a la normalidad para una mujer postmenopáusica. El diagnóstico causal de virilización en mujeres posmenopáusicas es un desafío, y por lo general están asociadas con patologías poco frecuentes. Una historia clínica detallada es fundamental para diferenciar el desarrollo progresivo de virilización que caracteriza las causas benignas de la rápida progresión que caracteriza a los tumores malignos. La interpretación de pruebas correctas de laboratorio con imágenes complementarias, así como la búsqueda de antecedentes de riesgo cardiovascular como la diabetes y la hipertensión asociadas son fundamentales para establecer un correcto diagnóstico y tratamiento.

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Ovarian Stromal Hyperplasia: A Rare Cause of Postmenopausal Hyperandrogenism

Cited by 8 publications

References 14 publications

How hairfall saved the patient from cancer twice – A postmenopausal patient with synchronous endometrial and endocervical carcinomas presenting with endocrine symptoms

How hairfall saved the patient from cancer twice – A postmenopausal patient with synchronous endometrial and endocervical carcinomas presenting with endocrine symptoms

Rare case of coexisting ovarian Brenner tumour and ovarian stromal hyperplasia presenting with persistent endometrial hyperplasia following treatment with levonorgestrel-intrauterine system

Virilización y enfermedad metabólica en mujer postmenopáusica relacionado a hiperplasia e hipertecosis ovárica

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