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Case Reports
. 2010 Dec 14:2010:bcr0720103139.
doi: 10.1136/bcr.07.2010.3139.

Virilising ovarian tumour in a woman with an adrenal nodule

Maria Luisa Cecilia Rivera-Arkoncel  1 , Debby Pacquing-Songco, Frances Lina Lantion-Ang
Affiliations
Case Reports

Virilising ovarian tumour in a woman with an adrenal nodule

Maria Luisa Cecilia Rivera-Arkoncel et al. BMJ Case Rep. .

Abstract

Androgen secreting tumours are the least commonly encountered androgen excess disorders, having a prevalence of 0.2%. Androblastomas of the ovary comprise less than 0.5% of all ovarian tumours. Pure Leydig cell tumours are very rare and almost always show secretion of male sex hormones. A 41-year-old multipara Filipino woman presented with a 2-year history of amenorrhoea and virilisation characterised by hirsutism, androgenic alopecia, masculine habitus and clitoromegaly. Diagnostic evaluation showed markedly elevated serum testosterone and normal dehydroepiandrosterone sulfate. Normal ovaries were seen on initial transvaginal ultrasound. A low dose dexamethasone suppression test suggested an ovarian source. A left adrenal nodule was seen on CT scan. Doppler transvaginal ultrasound revealed a solid lobulated structure in the right ovary. The patient underwent surgery and histopathology showed a Leydig cell tumour, hilar type. Serum testosterone levels normalised 3 days after surgery. Specific clinical and biochemical investigation of androgen secreting neoplasms is very important for correct diagnosis of these rare tumours.

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Conflict of interest statement

Competing interests None.

Figures

Figure 1
Figure 1
Marked frontotemporal balding/androgenic alopecia.
Figure 2
Figure 2
The patient showing male habitus.
Figure 3
Figure 3
Pelvic examination revealed external genitalia typical of an adult female but with clitoromegaly.
Figure 4
Figure 4
Abdominal CT scan showed an isodense nodule located in the medial left adrenal gland measuring approximately 1×1.5 cm.
Figure 5
Figure 5
Doppler transvaginal ultrasound revealed a 3.7×2.5×2.2 cm solid lobulated structure in the right ovary with low resistance indices.
Figure 6
Figure 6
The right ovary had changed into a unilocular solid mass measuring 4×2.5×2 cm. The mass was firm and highly vascular.
Figure 7
Figure 7
On cut section, ¾ of the right ovary was noted to be a brownish, necrotic, firm lobulated mass.
Figure 8
Figure 8
Leydig cell tumour, hilar type. The tumour is composed of cells with abundant eosinophilic cytoplasm (A, lower left) or with abundant intracytoplasmic lipid (B, lower right). Note the characteristic Reinke crystal (centre).
Figure 9
Figure 9
Leydig cell tumour, hilar type. This tumour is well circumscribed. Note its location as regards the ovarian hilar vessels (H&E ×40).
See this image and copyright information in PMC

References

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Publication types

Supplementary concepts