Symptomatic Ovarian Steroid Cell Tumor not Otherwise Specified in a Post-Menopausal Woman

Abstract

Steroid cell tumor not otherwise specified (NOS) is a rare subtype of sex cord stromal tumor of the ovary and contributes less than 0.1% of all ovarian neoplasms. The majority of tumors occur in pre-menopausal women (mean age: 43 years), in which 56-77% of patients present with virilization due to excess testosterone. An 80-year-old woman with worsening alopecia and excessive growth of coarse hair on abdomen and genital area was found to have elevated serum testosterone level (462 ng/mL). Radiologic studies were consistent with bilateral adrenal adenomas. Bilateral adrenal venous sampling ruled out the adrenal gland as origin of hormone secretion. A diagnostic and therapeutic bilateral salpingo-oophorectomy confirmed steroid cell tumor NOS of the left ovary. Post-operatively, the patient had complete resolution of her symptoms and normalization of testosterone level. Our case emphasizes the importance of a clinical suspicion for an occult testosterone secreting ovarian tumor in a symptomatic patient without obvious ovarian mass on imaging.

Keywords: Steroid cell tumor not otherwise specified (NOS); adrenal venous sampling; virilization.

Figure 1.

A) High power Hematoxylin and Eosin view demonstrating nests of polygonal cells with eosinophilic cytoplasm. Focal cytoplasmic vacuolization is present. Nuclei are round with prominent nucleoli. No Reinke’s crystals are seen. B) Strong and diffuse cytoplasmic staining for Inhibin. C) Diffuse nuclear and cytoplasmic staining in the tumor cells for Calretinin.