Abstract
Background. Steroid cell ovarian tumors, not otherwise specified, represent a unique cause of female virilization. Most commonly encountered in premenopausal women, these tumors can exist throughout a women's lifetime, from before puberty until after menopause. Case. Steroid cell, not otherwise specified, was diagnosed in a 70-year-old female significant for hirsutism. The patient demonstrated elevated total testosterone levels with normal gonadotropins, DHEA, and DHEA-S levels. CT imaging revealed a right ovarian mass and subsequent laparoscopic right oophorectomy yielded clinical improvement promptly. Conclusion. Virilization in females can occur based on ovarian or adrenal pathology. In terms of ovarian-based female virilization, many tumors exist that may induce women to demonstrate masculine features, such as pure Sertoli, pure Leydig, Sertoli-Leydig combinations, and gynandroblastomas. Each of these tumor types possesses a unique histologic pattern that allows for pathologic identification after removal. A rare source of ovarian-based female virilization is steroid cell neoplasms, not otherwise specified, that do not demonstrate these specific histologic characteristics and thus represent a diagnosis of exclusion after other causes of ovarian-based female virilization have been ruled out.
Highlights
Not otherwise specified, represents a subset of steroid cell ovarian stromal tumors that are histologically identified based on their absence of pathognomonic features, such as Reinke Crystals, Call-Exner bodies, and prominent nucleoli, seen in other androgen secreting ovarian tumors
First described by Scully in 1979, steroid cell tumors represent less than 0.1% of all ovarian tumors and are grouped under the category of sex cord stromal tumors of the ovary
According to the WHO, the androgen secreting steroid cell tumors are further classified as either pure sertoli, sertoli-leydig, gynandroblastomas, or steroid cell, NOS, with the most common subtype being the latter, accounting for approximately 60% of steroid cell tumors
Summary
Not otherwise specified, represent a unique cause of female virilization. Virilization in females can occur based on ovarian or adrenal pathology. In terms of ovarian-based female virilization, many tumors exist that may induce women to demonstrate masculine features, such as pure Sertoli, pure Leydig, Sertoli-Leydig combinations, and gynandroblastomas. Each of these tumor types possesses a unique histologic pattern that allows for pathologic identification after removal. A rare source of ovarian-based female virilization is steroid cell neoplasms, not otherwise specified, that do not demonstrate these specific histologic characteristics and represent a diagnosis of exclusion after other causes of ovarian-based female virilization have been ruled out
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