Androgen-secreting borderline mucinous ovarian tumor in pregnancy: multidisciplinary management of gestational hyperandrogenism
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20262560Keywords:
Androgen-secreting ovarian tumor, Borderline mucinous ovarian tumor, Pregnancy, Gestational hyperandrogenism, Adnexal massAbstract
Most adnexal masses diagnosed during pregnancy are benign, but a subset is malignant, borderline, or hormonally active. Androgen-secreting tumors are particularly rare and carry an added risk of fetal virilization. We report the case of a 38-year-old pregnant woman incidentally diagnosed with a complex adnexal mass at 13 weeks of gestation, which showed progressive growth and was associated with elevated androgen levels suggestive of a functional tumor. A multidisciplinary team initiated conservative management with spironolactone to reduce the risk of fetal virilization, and surgery was performed at 28 weeks due to tumor growth progression. Histopathology confirmed a borderline mucinous tumor with Leydig cell hyperplasia. The patient had an uneventful recovery, with normalization of testosterone levels and a term delivery of a healthy newborn with no signs of virilization. This case, compared with the only three previously reported cases of this tumor in pregnancy, illustrates that an individualized, multidisciplinary approach to gestational hyperandrogenism caused by adnexal masses, combining conservative management with timely surgical intervention when indicated, can achieve favorable maternal and fetal outcomes.
Metrics
References
Cathcart AM, Nezhat FR, Emerson J, Pejovic T, Nezhat CH, Nezhat CR. Adnexal masses during pregnancy: diagnosis, treatment, and prognosis. Am J Obstet Gynecol. 2023;228(6):601-12. DOI: https://doi.org/10.1016/j.ajog.2022.11.1291
Cavaco-Gomes J, Jorge Moreira C, Rocha A, Mota R, Paiva V, Costa A. Investigation and Management of Adnexal Masses in Pregnancy. Scientifica. 2016;2016(1):3012802. DOI: https://doi.org/10.1155/2016/3012802
Kipp B, Vidal A, Lenick D, Christmann-Schmid C. Management of Borderline ovarian tumors (BOT): results of a retrospective, single center study in Switzerland. J Ovarian Res. 2023;16(1):20. DOI: https://doi.org/10.1186/s13048-023-01107-3
Macut D, Ilić D, Mitrović Jovanović A, Bjekić-Macut J. Androgen-Secreting Ovarian Tumors. Front Horm Res. 2019;53:100-7. DOI: https://doi.org/10.1159/000494906
Andreotti RF, Timmerman D, Strachowski LM, Froyman W, Benacerraf BR, Bennett GL, et al. O-RADS US Risk Stratification and Management System: A Consensus Guideline from the ACR Ovarian-Adnexal Reporting and Data System Committee. Radiology. 2020;294(1):168-85. DOI: https://doi.org/10.1148/radiol.2019191150
McClamrock HD. Pregnancy-Related Androgen Excess. In: Azziz R, Nestler JE, Dewailly D, editors. Androgen Excess Disorders in Women: Polycystic Ovary Syndrome and Other Disorders. Totowa, NJ: Humana Press; 2007:107-19. DOI: https://doi.org/10.1007/978-1-59745-179-6_9
Rojewska P, Meczekalski B, Bala G, Luisi S, Podfigurna A. From diagnosis to treatment of androgen-secreting ovarian tumors: a practical approach. Gynecol Endocrinol. 2022;38(7):537-42. DOI: https://doi.org/10.1080/09513590.2022.2083104
8. Robertson DM, Oehler MK. Emerging role of inhibin as a biomarker for ovarian cancer. Womens Health (Lond). 2005;1(1):51-7. DOI: https://doi.org/10.1517/17455057.1.1.051
Liszewski W, Boull C. Lack of evidence for feminization of males exposed to spironolactone in utero: A systematic review. J Am Acad Dermatol. 2019;80(4):1147-8. DOI: https://doi.org/10.1016/j.jaad.2018.10.023
Deng N, Zhong J, Deng Z, Chen M, Yan L, Li H, et al. Case report: A pregnant woman accidental treated with spironolactone in mid-gestation. Front Pharmacol. 2024;15:1404251. DOI: https://doi.org/10.3389/fphar.2024.1404251
Groves TD, Corenblum B. Spironolactone therapy during human pregnancy. Am J Obstet Gynecol. 1995;172(5):1655-6. DOI: https://doi.org/10.1016/0002-9378(95)90549-9
Yen CF, Lin SL, Murk W, Wang CJ, Lee CL, Soong YK, et al. Risk analysis of torsion and malignancy for adnexal masses during pregnancy. Fertil Steril. 2009;91(5):1895-902. DOI: https://doi.org/10.1016/j.fertnstert.2008.02.014
Ye P, Zhao N, Shu J, Shen H, Wang Y, Chen L, et al. Laparoscopy versus open surgery for adnexal masses in pregnancy: a meta-analytic review. Arch Gynecol Obstet. 2019;299(3):625-34. DOI: https://doi.org/10.1007/s00404-018-05039-y
Querleu D, Planchamp F, Chiva L, Fotopoulou C, Barton D, Cibula D, et al. European Society of Gynaecological Oncology (ESGO) Guidelines for Ovarian Cancer Surgery. Int J Gynecol Cancer. 2017;27(7):1534-42. DOI: https://doi.org/10.1097/IGC.0000000000001041
Timmerman D, Ameye L, Fischerova D, Epstein E, Melis GB, Guerriero S, et al. Simple ultrasound rules to distinguish between benign and malignant adnexal masses before surgery: prospective validation by IOTA group. Bmj. 2010;341:c6839. DOI: https://doi.org/10.1136/bmj.c6839
Casanova J, Maciel R, Ferreira V, Fernandes E, Rodrigues RM. Borderline Ovarian Tumor during Pregnancy: A Case Report. Case Rep Obstet Gynecol. 2013;2013:160319. DOI: https://doi.org/10.1155/2013/160319
Fanara E, Darnis E, Winer N, Kandel C, Laboisse CL, Philippe H. Tumeur ovarienne mucineuse virilisante et grossesse: à propos d’un cas. Journal De Gynecologie Obstetrique Et Biologie De La Reproduction. 2008;37:524-7. DOI: https://doi.org/10.1016/j.jgyn.2008.02.006
Pather S, Atkinson K, Wang I, Russell P, Kesby G, Carter J. Virilization in pregnancy due to a borderline mucinous ovarian tumor. J Obstet Gynaecol Res. 2007;33(3):384-7. DOI: https://doi.org/10.1111/j.1447-0756.2007.00542.x