Androgen-producing steroid cell ovarian tumor in a young woman and subsequent spontaneous pregnancy

Abstract

Purpose: To describe the presentation and fertility sparing treatment of a young woman found to have a steroid cell tumor not otherwise specified (NOS) and her spontaneous pregnancy and delivery shortly after surgery.

Methods: A 20-year-old Hispanic female presented with hirsuitism, virilization, and elevated androgen levels (testosterone 328 ng/dL) and was wrongly diagnosed with polycystic ovarian syndrome. Four months later she sought a second opinion. Her androgens were as follows: testosterone level 485 ng/dL, androstenedione 1,738 ng/dL and DHEA 1,459 ng/dL. She had normal levels of progesterone, estradiol, and DHEA-SO4. On transvaginal ultrasound she had a solid-appearing right ovarian mass. She underwent fertility sparing surgery with a laparoscopic right oophorectomy.

Results: Gross and histological pathology confirmed a benign steroid cell tumor NOS. She had rapid normalization of all androgens 13 days after surgery. She had spontaneous resumption of menses 4 months later. She conceived despite using emergency contraception approximately 9 months following surgery and delivered a healthy boy at term without complication.

Conclusion: Prompt evaluation for an androgen producing tumor should be performed when testosterone levels are greater than 200 ng/dL. Pregnancy following removal of this rare tumor has not previously been reported.

Fig. 1

The ovarian tumor cut surfaces are well-circumscribed, yellow-orange, and lobulated

Fig. 2

Histology of the steroid cell tumor not otherwise specified (NOS). a Diffuse growth pattern with two cell types, eosinophilic cells and clear cells (40× magnification). b The eosinophilic cells with abundant eosinophilic granular cytoplasm and small to intermediate nuclei with small nucleoli and distinct cell borders (200× magnification). c The clear cells vacuolated clear cytoplasm and small nuclei (200× magnification)

Fig. 3

Tumor cells (a) stain positive for alpha-inhibin (100× magnification) and (b) stain positive for calretinin (100× magnification)