Pseudoclitoromegaly from acute T-cell lymphoblastic leukemia

Abstract

A 7-year-old girl presented with painful genital enlargement, which was first believed to be clitoromegaly of hormonal origin. However, on the physical exam the clitoris was not visible and the prepuce and labia minora were enlarged and tender. Magnetic resonance imaging demonstrated an infiltrative abnormal signal with restricted diffusion involving the enlarged clitoris and adjacent soft tissues of the prepuce and labia minora, confirming a nonhormonal infiltrative malignancy. The same abnormal signal was present in enlarged inguinal lymph nodes, the kidneys, and an anterior mediastinal mass. The pathologic diagnosis was T-cell acute lymphoblastic leukemia.

Keywords: Clitoris; clitoromegaly; leukemia; magnetic resonance imaging; malignancy.

Figure 1.

Clinical photograph demonstrating massive enlargement of the clitoral hood and labia minora. The clitoris is not identified.

Figure 2.

Magnetic resonance imaging of the pelvis. (a) Axial T2-weighted image showing mild enlargement and intermediate signal of the clitoris (double-headed arrow) and surrounding soft issues (arrow). (b) Axial apparent diffusion coefficient map showing hypointense signal (arrow) confirming restricted diffusion that is commonly seen in tumors with a high nuclear to cytoplasmic ratio and is the typical signal for lymphoma/leukemia. Bilateral renal lesions, retroperitoneal adenopathy, and the chest mass demonstrated identical signal characteristics (not shown).