Use of hormone suppression then oocyte freezing to preserve reproductive capability in an adolescent girl with ovarian luteinized thecoma associated with sclerosing peritonitis

Abstract

Objective: To describe a case of ovarian luteinized thecoma, a rare ovarian neoplasm, which is only the 26th reported case associated with sclerosing peritonitis.

Design: Case report.

Setting: NYU Fertility Center and Memorial Hospital for Cancer and Allied Diseases, New York.

Patient(s): A 17-year-old woman presenting with a large pelvic mass and abdominal pain.

Intervention(s): Conservative surgical treatment with laparotomy, unilateral salpingooophorectomy, and biopsy of contralateral ovary. Gonadotropin-releasing hormone agonist suppression. Ovarian hyperstimulation with oocyte retrieval/freezing to preserve biologic fertility.

Main outcome measure(s): Response to conservative therapy and oocyte cryopreservation as a method of fertility preservation.

Result(s): At laparotomy, obvious unilateral ovarian involvement was present, and a left salpingoophorectomy was performed. Biopsy of the contralateral ovary confirmed bilateral disease. The initial pathological review was complicated by extensive ovarian edema. The patient was treated with gonadotropin-releasing hormone agonist suppression plus intermittent estradiol supplementation. When she became intolerant of hormone therapy and when removal of the remaining ovary became a possibility, she underwent ovarian hyperstimulation; oocyte retrieval and freezing were performed to preserve her biologic fertility. Thirty-eight eggs were obtained.

Conclusion(s): Surgically diagnosed luteinized thecoma can be managed medically. Oocyte cryopreservation as a means of fertility preservation should be considered in young women with this diagnosis who are at risk for bilateral gonad removal.