Steroid cell tumor: a rare cause of hirsutism in a female

Abstract

Ovarian steroid cell tumors are very rare functioning sex-cord stromal tumors. They comprise <0.1% of all ovarian tumors. Previously designated as lipoid cell tumors, one-third of these tumors are considered malignant with the mean age of presentation at around 40 years. We present a case of a 28-year-old female with 2-year history of hirsutism, virilization, and amenorrhea. She was diagnosed with left ovarian tumor, for which she underwent left salpingo-oophorectomy. Histopathology revealed not otherwise specified subtype of steroid cell tumors. The patient resumed menses 2 months after the features of masculinization regressed. Within 1 year of surgery, the patient successfully conceived a full-term baby without any complications. In a young female, the neoplastic etiology of a rapid virilization or menses changing should always be kept in mind. Though commonly observed in adult females, steroid cell tumors have very good surgical outcomes if age at presentation is less and tumor is unilateral, and there are no evidences of bilateral malignancy. Bilateral salpingo-oophorectomy is not required.

Learning points: In a case of severe rapid hirsutism and virilization with serum testosterone level more than 200 ng/dl or more than threefold of the normal range, neoplastic conditions should always be suspected.Steroid cell tumor in young women without evidence of malignancy on histopathology has excellent surgical outcomes.Unilateral salpingo-oophorectomy is the surgery of choice.As the frequency of bilateralism is only 6%, prophylactic unaffected side oophorectomy need not be done.

Figure 1

A 28-year-old female with severe virilization.

Figure 2

Histopathology of the tumor showing vacuolated clear cells suggestive of NOS subtype of steroid cell tumor.