The inner alchemy: a steroid cell transformation of ovary

Abstract

Steroid cell tumors (SCTs) are an uncommon subset of ovarian sex cord-stromal tumors, accounting for approximately 0.1% of all ovarian neoplasms. They are categorized into three subtypes based on cellular origin: Leydig cell tumors, stromal luteomas, and SCTs not otherwise specified (SCT-NOS). SCT-NOS is characterized by an uncertain lineage and a higher likelihood of hormonal activity. These tumors are frequently functional, most commonly secreting testosterone, and may present with clinical features of hyperandrogenism, including virilization, hirsutism, and menstrual disturbances such as amenorrhea. Given their rarity and variable presentation, SCT-NOS tumors pose a diagnostic challenge and require careful clinical, biochemical, radiological, and histopathological correlation for accurate diagnosis and management. This case highlights a 20-year-old female who presented with virilization, sudden voice change, hirsutism, acne, and abnormal uterine bleeding. Ultrasound showed a solid nodule in the right ovary, and salpingo-oophorectomy was performed. Histology confirmed a SCT-NOS of the right ovary. Postoperatively, the patient made a remarkable recovery of menstrual symptoms, demonstrating the importance of prompt diagnosis and surgical management in such cases. During follow-up, she has remained asymptomatic, with no evidence of tumor recurrence on clinical or imaging evaluation.