Abstract
Steroid cell tumors not otherwise specified (NOS) are a rare subgroup of sex cord-stromal tumors. The tumors can occur at any age, although the mean age of occurrence is 43 years old. The majority are benign, but have the capability of producing one or more steroids associated with virilization. The present study reports the case of a 29-year-old female who presented to the Second Xiangya Hospital suffering from lower back and leg pain that had persisted for five months. The patient had regular menstrual cycles and no virilization symptoms were present. Laboratory investigations revealed normal hormone levels. Multiple areas of bone destruction and a right ovarian mass were confirmed via positron emission tomography/computed tomography. The patient underwent an exploratory laparotomy, and a mass measuring ~6 cm in diameter was subsequently identified in the right ovary. A right salpingo-oophorectomy and pelvic washings for cytology were performed. Histopathological studies confirmed the diagnosis of a malignant steroid cell tumor NOS of the right ovary. The patient underwent eight cycles of chemotherapy (docetaxel, 120 mg and nedaplatin, 80 mg). The patient continued to have relatively good health, with no deterioration of the condition for one year and a half, however, the disease progressed and the patient succumbed to brain metastases six months later.
Highlights
A description of ovarian steroid cell tumors was first provided in 1979 by Scully [1]
The present study reports a case of a malignant steroid cell tumor not otherwise specified (NOS) in a patient younger than the mean age of occurrence, with lower back and leg pain as the initial symptoms, and with a lack of endocrine symptoms
NOS is a subtype of steroid cell tumors; their cell lineage is not defined and they cannot be categorized as either stromal luteomas or Leydig cell tumors
Summary
A description of ovarian steroid cell tumors was first provided in 1979 by Scully [1]. A pelvic examination revealed a 5x5x6‐cm solid right adnexal mass. Laboratory workups revealed that the levels of sex and thyroid hormones, and 12 types of serum tumor markers, including cancer antigen (CA)‐125 and CA19‐9, were within the normal limits. A transvaginal pelvic ultrasound showed a 57x36‐mm solid‐cystic mass of the right ovary. A 33x64‐mm solid‐cystic mass was detected on the right in the rear of the pelvis, indicating the possibility of ovarian cancer (Fig. 1B). A well‐encapsulated and solid 6x6‐cm mass was located occupying 90% of the right ovarian tissue, without any adhesions to the surrounding structures. A frozen section of the mass revealed a malignant tumor, which could not be classified, with large areas of necrotic tissue. The clinical findings, histomorphology and immunohistochemistry of the mass revealed a diagnosis of malignant ovarian steroid cell tumor NOS. Following this, the disease progressed and the patient succumbed 6 months later from brain metastases
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