Ovarian stromal tumor with minor sex-cord element with virilizing menifestations: a rare case report

Authors

  • Reena Sharma Department of Obstetrics & Gynecology, Dr. RPGMC Tanda, Kangra, Himachal Pardesh, India
  • Anju Vij Department of Obstetrics & Gynecology, Dr. RPGMC Tanda, Kangra, Himachal Pardesh, India
  • Neelam Mahajan Department of Obstetrics & Gynecology, Dr. RPGMC Tanda, Kangra, Himachal Pardesh, India
  • Usha Kumari Chaudhary Department of Anaesthesia, Dr. RPGMC Tanda, Kangra, Himachal Pardesh, India
  • Ajay Sharma Department of Cardiology, Dr. RPGMC Tanda, Kangra, Himachal Pardesh, India
  • Arvind Kumar Department of Pharmacology, Dr. RPGMC Tanda, Kangra, Himachal Pardesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20151332

Keywords:

Virilising ovarian tumor, Sex cord stromal tumor, Hirsutism, Hysterectomy, Virilization

Abstract

Sex cord stromal tumor is a rare variety of ovarian tumor. These tumor have association with testosterone production which lead to virilisation in females. Here we report a case of 40yrs old female P2 L2 who presented with clinical signs and symptoms of virilisation: deepening of voice, hirsutism (Ferriman Gallwey score24), clitoromegaly, and breast atrophy. In this patient, serum testosterone and TSH levels were raised.  An ovarian mass was detected on ultrasonography. Exploratory laparotomy proceeds, total abdominal hysterectomy with bilateral salpingo-opherectomy was done. On histopathological examination the ovarian mass turned out a sex-cord stromal tumor of fibroma thecoma group-cellular fibroma with minor sex-cord like elements. Post-operatively her serum testosterone level declined and signs and symptoms of virilisation started regressing. 

References

Ehrmann DA. Hirsutism and virilisation. In Harrison’s Principles pf Internal Medicine. 17th edition. Edited by Anthony S Fauci, Dennis L Kasper, Dan L Longo, Eugene Braunwald, Stphen L Hauser, Larry J Jameson, Joseph Loscalzo: New York, McGraw-Hill Medical; 2008: 301-304.

Fox H. Sex cord-stromal tumours of the ovary. J Pathol. 1985;145:127-48.

Keeney GL. Ovarian tumours with endocrine menifestations. In: De Groot LJ, editor. Endocrinology. 4th ed. Philadelphia (PA): WB Saunders Company. 2001: 2172.

Stenger HE, Loning T. Endocrine-active tumors of the ovary. Pathologe. 2003;24:314-22.

Siekierska-Hellmann M, Sworczakm K, Babinska A, Wojtylak S. Ovarian thecoma with andogenic menifestations in a postmenopausal women. Gynecol Endocrinol. 2006;22:405-8.

Shenker Y, Malozowski SN, Ayers J, Grekin RJ, Barken AL. Steroid secretion by a virilising lipoid cell ovarian tumor: origins of dehydro epiandrosterone sulphate. Obstet Gynecol. 1989;74:502-6.

Faraj G, Di Gregorio S, Misiunas A, Faure AN, Villabrile P, Stringa I, Petroff N, Bur G: Virilizing ovarian tumor of cell type not otherwise specified: a case report. Gynecol Endocrinol. 1998;12:347-52.

Aimkhu VE, Adeleye JA, Hendrickse M, De Von Hedrickse JP, Iioabachie G: Masculinizing tumors of the ovary. J Natl Med Assoc. 1976:68(1):34-8.

Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 22-1982. A nine year old girl with virilisation and a calcified pelvic mass. N Engl J Med. 1982;306:1348-55.

Dunnihoo DR, Grieme DL, Woolf RB. Hilar-cell tumors of the ovary. Report of 2 new cases and a review of the world literature. Obstet Gynecol. 1966;27:703-13.

Colombo Ni, Parma Ga. Ovarian sex cord stromal tumors. In: edited by Gershenson DM, Mcguire Mc, Gore M, Quinn MA, Thomas G. Gynecologic Cancer. 2nd Ed. USA: Elsevier; 2005: 503-507.

Roth LM. Sex cord stromal tumor of the ovary. Young RH, Scully RE. Steriod cell tumor of the ovary. In: Fox H, Wells M, editors. Obstetrical and Gynecological pathology. 5th ed. United Kingdom. 2003;745-765, 845-849.

Renshaw AA, Gordon M, Coreless CL. Immunonohistochemistry of unclassified sex cord-stromal tumors of the testis with a predominance of spindle cells. Mod Pathol. 1997;10:693-700.

Young RH, Scully RE. Ovarian stromal tumors with minor sex cord elements: a report of seven cases. Int J Gynecol Pathol. 1983;2:227-34.

Young RH, Scully RE. Sex-cord stromal steroid cell and other ovarian tumors with endocrine, paraendocrine and paraneoplastic menifestations. In Blaustein’s pathology of the female genital tract. 4th ed. Edited by Kurman RJ: New York, Springer-Verlag. 1994:783-847.

Wang PH, Chao HT, Lee RC, Lai CR, Lee WL, Kwok CF, et al. Steriod cell tumors of the ovary: clinical, ultrasonic, and MRI diagnosis- a case report. Eur J Radiol. 1998;26(3):269-73.

Scully RE. Classification of human ovarian tumors. Environmental Health Perspectives. 1987;78:15-24.

Monteagudo A, Heller D, Husami N, Levine RU, McCaffrey R, Timortritsch IE. Ovarian steroid cells tumors: sonographic chartetristics. Ultrasound Obstetrics Gynecology. 1997;10:282-8.

Outwater EK, Marchetto B, Wagne BJ. Virilising tumors of the ovary: imaging features. Ultrasound Obstet gynecol. 2000; 15(5):365-71.

Faria AM, Perez RV, Marcondes JA, Freire DS, Blasblag R, Soares J, et al. A premenopausal woman with virilisation secondary to an ovarian Leydig cell tumor. Nat Rev Endocrinol. 2011;7(4):240-5.

O’Driscoll JB, Mamtora H, Higginson J, Pollock A, Kane J, Anderson DC. A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism and andogenic alopecia. Clin Endocrinol. 1994;41:231-6.

Derksen J, Nagesser SK, Meinders AE, Haak HR, Van de valde CJ. Identification of virilising adrenal tumors in hirsute women. N Eng J Med. 1994;331:968-73.

Azziz R, Dewailly D, Owerbach D. Clinical review 56: Nonclassic adrenal hyperplasia. J clin Endocrinol Metab. 1994;78:810-5.

Zhang J, Young RH, Arseneau J, Scully RE. Ovarian stromal tumor containing lutein or Leydig cells (leutinised thecomas and stromal leydig cell tumors): a clinicopathological analysis of fifty cases. Int J Gynecol Pathol. 1982;1:270-85.

Byrne P, Vella EJ, Rollason T, Frampton J. Ovarian fibromatosis with minor sex cord elements. Arch J Obstet Gynecol. 1989;96:245-54.

Piver MS. Ovarian malignancies: diagnostic and therapeutic advances. Edinburgh: Churchill Livingstone. 1987:251-71.

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Published

2017-02-19