A rare ovarian tumor, leydig stromal cell tumor, presenting with virilization: a case report
A 41-year-old woman with a 5-year history of amenorrhoea was admitted to our hospital because of relapsing vaginal bleeding, hirsutism, acne, some skin lesion especially on her abdomen, deepening of the voice and feeling of pressure in the pelvic for past 6 months. She first had gone to a dermatologist office with an excessive hair growth on the body and acne. Because of an abnormality in her serum androgen and a pelvic mass in the ultrasonography, physician referred her to a gynecologist.\nHigh levels of circulating total testosterone and free testosterone were found. Both FSH and LH were below 0.5 (Iu/L). Adreno-corticotropin hormon (ACTH), dehydro-epiandrostone sulfate (DHEAS), thyroid function test and urine free cortisol level with a volume of 1300ml were normal. CEA and CA125 biomerkers were also normal.\nUltra sound revealed a uterus with 12.5 x 3.8x7 cm in diameters with a myomatosis pattern and an endometrial length of 7mm. A heterogenous mass of about 62x65mm with multiple calcification areas was seen in right adenex, so an ovarian mass or pedunculated myoma was suggested. On her transvaginal examination, right adenex fullness with a uterus larger than normal size in a postmenopausal woman was detected.\nShe underwent an exploratory laparatomy, total hysterectomy, infracolic omentectomy, bilateral salpingo-oophorectomy and peritoneal washings.\nIn pathologic report, macroscopic finding includes an encapsulated creamy – gray solid mass with smooth and lobulated external surface, with areas of orange discoloration. In microscopy: ovarian stroma, leydig cells and spindle stromal cells without atypia were seen (, ).\nA benign Leydig stromal cell tumor was reported with no omental or lymph node involvement and cytology of peritoneal washing was negative for malignant cell. Abdominal skin biopsy showed no significant pathologic change. At post operative follow-up, serum testosterone level decreased, and there was regression of the virilizing changes.