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Ovarian Leydig Cell Tumor: Cause of Virilization in a Postmenopausal Woman

Challenging differential diagnosis, Rare disease

Nádia Mourinho Bala, José Maria Aragüés, Sílvia Guerra, Delfina Brito, Cristina Valadas

Portugal Department of Endocrinology, Hospital Beatriz Ângelo, Loures, Portugal

Am J Case Rep 2021; 22:e933126

DOI: 10.12659/AJCR.933126

Available online: 2021-07-16

Published: 2021-08-27


#933126

BACKGROUND: Only 0.5% of all ovarian tumors are Leydig cell tumors and they are generally benign and unilateral. These androgen-secreting tumors lead to virilizing symptoms, most often in postmenopausal women. Because Leydig cell tumors are typically small, diagnosing them accurately can be challenging.
CASE REPORT: We report the case of a 77-year-old woman who was referred to our Endocrinology Clinic because of a 5-year history of hirsutism (Ferriman-Gallwey score of 11) with no discernible cause. The patient had high levels of serum testosterone and a normal level of dehydroepiandrosterone sulfate. Imaging, including transvaginal ultrasound and pelvic magnetic resonance, revealed a 16-mm uterine nodule, which was suspected to be a submucous leiomyoma, but no adrenal or ovarian lesions. Despite the lack of findings on imaging and because of the high suspicion for an androgen-secreting ovarian tumor, bilateral laparoscopic oophorectomy was performed. Histological examination of the specimen revealed a non-hilar Leydig cell tumor that measured 8 mm in its largest axis. After the surgery, the patient had significant clinical improvement and her laboratory test results normalized. Her sister had the same symptoms and laboratory findings at a similar age, which raised the suspicion of a possible familial genetic syndrome. No genetic testing was performed, however, because the patient’s sister declined further diagnostic investigation.
CONCLUSIONS: Leydig cell tumors are rare, and even when they are small, they can cause symptoms related to androgen excess. As a result, diagnosing them often is challenging.

Keywords: hyperandrogenism, Leydig Cell Tumor, Postmenopause



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