Ovarian Stromal Hyperthecosis Research Articles

Hyperandrogenism due to ovarian stromal hyperthecosis in a woman known with PCOS

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Value of selective venous catheterization in the diagnosis of hyperandrogenism

To discuss the clinical utility of ovarian vessel sampling in the context of the evaluation and treatment of ovarian hyperthecosis. Patient presentation in video format, ovarian vessel sampling demonstration, surgical technique explanation, surgical histology discussion and ovarian hyperthecosis review. Academic medical center. A 30-year-old nulligravid female presented with severe hyperandrogenic features, consistent with polycystic ovary syndrome. During the course of her diagnostic evaluation, she underwent selective ovarian and adrenal vein sampling. Assessment of ovarian vessel testosterone levels and review of final histologic findings. Selective ovarian and adrenal vein sampling revealed right ovarian testosterone levels that were 200 times the upper limit of normal. As occult malignancy was a concern, laparoscopy was performed, with nearly complete removal of the right ovarian stroma. Pathology revealed ovarian stromal hyperthecosis without evidence of malignancy. Selective venous sampling is a technically challenging procedure, which may help localize an occult malignancy in limited circumstances. In utilizing selective venous sampling, one must consider the limitations of thetest, potential for false positive results, and possibility of unnecessary surgical interventions.

Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies.

The presence of virilizing signs associated with high serum androgen levels in postmenopausal women is rare. Virilizing ovarian tumors (VOTs) and ovarian stromal hyperthecosis (OH) are the most common etiologies in virilized postmenopausal women. The differential diagnosis between these two conditions is often difficult. To evaluate the contribution of clinical features, hormonal profiles and radiological studies to the differential diagnosis of VOT and OH. A retrospective study. A tertiary center. Clinical data, hormonal status (T, E2, LH and FSH), pelvic images (transvaginal sonography and MRI) and anatomopathology were reviewed. Thirty-four postmenopausal women with a diagnosis of VOT (13 women) and OH (21 women) were evaluated retrospectively. Clinical signs of hyperandrogenism were more prevalent in the VOT group than the OH group. Although the VOT group showed higher T and E2 levels and lower gonadotropin levels than the OH group, a great overlap occurred among the hormone levels. A pelvic MRI provided an accurate differentiation of these two conditions. In this group of patients, the main features contributing to the differential diagnosis of VOT and OH were serum levels of testosterone and gonadotropins and the presence of an ovarian nodule identified on the MRI. Although the association of clinical, hormonal and radiological features contributes to the differential diagnosis of these two conditions, histopathological analysis remains the gold standard for the diagnosis of ovarian hyperandrogenism in postmenopausal women.

Paradoxical glycaemic response to surgical treatment of ovarian hyperthecosis in a patient with type 2 diabetes

Introduction Ovarian stromal hyperthecosis in post-menopausal women is a rare disorder characterised by gradual virilisation and features of the metabolic syndrome similar to PCOS.1 Improvement of diabetic control in hyperthecosis has been reported following oophorectomy, perhaps secondary to normalisation of the hyperandrogenaemia.2 This is a report of worsening diabetes following oophorectomy. The case and possible explanations for the response are described.

Ovarian stromal hyperthecosis

The review analyzes the data on pathogenesis, prevalence, pathomorphology, clinical manifestations, diagnosis and treatment of ovarian stromal hyperthecosis. This condition is characterized by severe hyperandrogenism and impaired glucose tolerance, and it is mostly occurs in postmenopausal women. Main cause of androgenic hyperproduction in women of reproductive age - the polycystic ovary syndrome - is thoroughly studied; standards for diagnostics and treatment for such patients are developed. Little is known about stromal hyperthecosis, which is a more rare cause of hyperandrogenism that had been considered as a severe form of polycystic ovary syndrome. However, it became an independent nosological form after a detailed study of the pathomorphology. Currently, there are no generally accepted diagnostic criteria for stromal hyperthecosis. This is not only because the disease is rare, but also due to the difficulty of making the final diagnosis. Patients with stromal hyperthecosis are at high risk for developing malignancies - endometrial cancer or breast cancer. So, the need for further investigation and developing treatment approaches is undoubted. In majority of cases, the diagnosis of stromal hyperthecosis is set on histological examination of ovarian tissue from patients with idiopathic severe hyperandrogenism, infertility or cancer. The practicing obstetrician-gynecologist must be aware of this condition to suspect the ovarian stromal hyperthecosis when its typical clinical features manifest, to perform meticulous laboratory and instrumental investigation and to choose the correct management tactics for such patients.

Magnetic resonance imaging findings of ovarian stromal hyperthecosis

Ovarian stromal hyperthecosis is characterized by diffuse distribution of luteinized stromal cells accompanied by varying degrees of stromal hyperplasia. We report a case of ovarian stromal hyperthecosis with particular regard to magnetic resonance (MR)-pathologic correlation. At initial MR imaging, the central areas of the bilateral ovarian masses showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images, while the peripheries of the bilateral masses showed isointensity to myometrium on T1-weighted images and heterogeneous signal intensities on T2-weighted images. At 15 days after the initial MR imaging examination, a second MR imaging demonstrated shrinkage of the bilateral ovarian masses. Change in the peripheries to predominantly isointensity to myometrium on the T2-weighted images was also observed. The patient underwent bilateral oophorectomy. Microscopic examination revealed scattered nests of lutein cells on a background of densely proliferated ovarian stroma with minimal collagen production in both ovaries. Edema was occasionally seen in the outer portion but was marked in the central zone of the ovaries, particularly on the left. The final pathologic diagnosis was stromal hyperthecosis. With regard to MR-pathologic correlation, the MR findings in the peripheries of the bilateral masses (isointensity relative to myometrium on both T1- and T2-weighted imaging) showed the characteristics of stromal hyperthecosis.

Ovarian Stromal Hyperthecosis

Ovarian stromal hyperthecosis (SH) has variable clinical importance but can cause hyperandrogenism, particularly in premenopausal women. Sonography is often used to evaluate the ovaries of women with hyperandrogenism, but there is little published regarding the sonographic appearance of SH. The primary purpose of this study was to describe the sonographic features of SH. A computerized search of our institution's pathology and imaging databases from 1996 through 2007 was performed to identify patients with histologically proven SH who had pelvic sonography before surgery. Sonograms and histologic findings were reviewed in each case. Twenty ovaries with SH were identified, occurring in 14 patients with a mean age of 59.8 years (range, 36-83 years). The SH was bilateral in 6 patients, unilateral in 6, and of uncertain laterality in 2 with a unilateral oophorectomy. Sonographic findings were as follows: 5 normal, 1 with a hemorrhagic cyst (later resolved) and otherwise normal, 3 enlarged but otherwise normal, 1 with a solid mass due to the nodular form of SH, 1 with a solid mass due to a fibroma, 2 with polycystic ovaries, and 7 not seen. Six of the 14 patients (43%) also had an ovarian fibrothecoma. Ovarian SH has variable sonographic features. Most commonly, the affected ovaries are either normal or slightly enlarged. A solid mass may infrequently be visible, and polycystic ovary syndrome changes may coexist with SH. A possible association of SH with fibrothecoma was also noted, which to our knowledge has not been previously reported.

OC207: Ovarian stromal hyperthecosis: sonographic features and histological associations

OC207: Ovarian stromal hyperthecosis: sonographic features and histological associations

Ectopic Bioactive Luteinizing Hormone Secretion by a Pancreatic Endocrine Tumor, Manifested as Luteinized Granulosa-Thecal Cell Tumor of the Ovaries

Endocrine pancreatic tumors are rare neoplasms consisting of multipotent cells capable of secreting various bioactive substances causing characteristic clinical syndromes. Ovarian stromal hyperthecosis is characterized by varying degrees of luteinized stromal cell proliferation after sustained LH and/or human chorionic gonadotropin stimulation, clinically manifested by symptoms/signs of virilization resembling the polycystic ovary syndrome (PCOS). We report a case of ectopic bioactive LH production from a pancreatic endocrine tumor in a 33-yr-old woman with rapidly developing symptoms/signs of hyperandrogenism and markedly elevated serum androgen and LH levels leading to hyperthecosis and bilateral luteinized granulosa-thecal cell tumors of the ovaries. Although the patient was initially thought to have either severe PCOS or an LH-secreting pituitary tumor, an LH-producing pancreatic endocrine tumor bearing somatostatin receptors was demonstrated on scintigraphy with [111In]octreotide and abdominal imaging. Symptoms and signs of hyperandrogenism resolved after the resection of the tumor. Immunohistochemistry, in situ hybridization, and electron microscopy studies confirmed LH synthesis by the tumor cell. Although extremely rare, ectopic LH production from nonpituitary endocrine tumors should be considered in the differential diagnosis of hyperandrogenism, particularly when associated with highly elevated serum LH levels.

R-237. Results of surgery in patients with ovarian stromal hyperthecosis and PCOS

R-237. Results of surgery in patients with ovarian stromal hyperthecosis and PCOS

Virilization in a postmenopausal woman due to ovarian stromal hyperthecosis

Virilization in women is occasionally caused by ovarian stromal hyperthecosis. Although three cases of post-menopausal women with hyperthecosis have been reported, the history in two of them strongly suggests a premenopausal origin. We describe a 64 year old woman with postmenopausal virilization due to bilateral ovarian stromal hyperthecosis.

Virilizing nodular ovarian stromal hyperthecosis, diabetes mellitus and insulin resistance in a postmenopausal woman. Case report

Virilizing nodular ovarian stromal hyperthecosis, diabetes mellitus and insulin resistance in a postmenopausal woman. Case report