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Case Reports
. 2020 Dec 22;13(12):e236427.
doi: 10.1136/bcr-2020-236427.

Bilateral microscopic Leydig cell ovarian tumors in the postmenopausal woman

Taylor L Langevin  1 , Karen Maynard  2   3 , Anil Dewan  4
Affiliations
Case Reports

Bilateral microscopic Leydig cell ovarian tumors in the postmenopausal woman

Taylor L Langevin et al. BMJ Case Rep. .

Abstract

A 64-year-old postmenopausal female patient presented with approximately 5 years of intermittent spotting, progressive hirsutism and significantly increased libido and clitoral hypersensitivity with spontaneous orgasms multiple times a day beginning a few months prior. Initial hormone work-up revealed elevated total serum testosterone, androstenedione and 17-hydroxyprogesterone. Luteinising hormone, follicle stimulating hormone, estradiol, dehydroepiandrosterone-sulfate, thyroid stimulating hormone and prolactin were all within normal limits. Initial suspicions suggested an androgen-secreting tumour, likely in the ovary. The lesion was undetectable on transvaginal ultrasound and abdominal-pelvic CT scan. Laparoscopic bilateral salpingo-oophorectomy was performed to remove the likely source of excess androgens. Visible gross lesions were not observed intraoperatively; however, bilateral Leydig (hilus cell) tumours were confirmed by histopathology. Serum testosterone, androstenedione and 17-hydroxyprogesterone levels were normalised postoperatively within 2 weeks and 1 month, respectively.

Keywords: gynaecological cancer; menopause (including HRT); reproductive medicine.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Laparoscopic view of uterus, bilateral fallopian tubes, and bilateral ovaries. No gross evidence of pathology.
Figure 2
Figure 2
Laparoscopic images of the left (A) and right (B) ovaries prior to bilateral salpingo-oophorectomy.
Figure 3
Figure 3
Histological image demonstrating normal ovarian parenchyma and stroma. H&E, ×25.
Figure 4
Figure 4
Histological image demonstrating atretic ovarian follicles forming the corpus albicans, ovarian parenchyma with tumour invasion and the stromal ovarian tumour. H&E, ×25.
Figure 5
Figure 5
Histological images of increasing magnification depicting ovarian stromal tumour Leydig cells. H&E, ×50 (A), H&E, ×200 (B) and H&E, ×400 (C).
See this image and copyright information in PMC

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