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Sun Y, Tian L, Meng C, Liu G. Ovarian steroid cell tumors, not otherwise specified: three case reports and literature review. Front Oncol 2024; 14:1400085. [PMID: 39026973 PMCID: PMC11254658 DOI: 10.3389/fonc.2024.1400085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 06/18/2024] [Indexed: 07/20/2024] Open
Abstract
Objective To provide a reference for the diagnosis and treatment of ovarian steroid cell tumors, not otherwise specified (SCTs-NOS). Methods We retrospectively analyzed the clinicopathological data of three patients with SCTs-NOS admitted to the Tianjin Medical University General Hospital from 2012 to 2022 and reviewed literature reports related to this disease. Results A total of 3 cases in our center and 70 cases searched in literature reports were included. The age at diagnosis ranged from 3 to 93 years (median, 34 years). The common clinical manifestations were hirsutism, acne, deepened voice, clitoromegaly, amenorrhea, and excessive weight gain. Tumor sizes ranged from 1.2 to 45 cm, with an average diameter of 6.5cm. Most of SCTs-NOS were benign, but some of them exhibited malignant behavior. Surgery was the main treatment and close follow-up was required. The follow up time of 73 cases ranged from 3 to 132 months (median, 21.3 months). Disease recurrence or progression occurred in 14 cases (19.2%). Three of the 73 patients had a successful pregnancy. Conclusion SCTs-NOS usually occur in women of reproductive age, which are mainly manifested as androgen excess symptoms. Surgery is an appropriate treatment for SCTs-NOS and should be individualized. Final diagnosis depends on pathology. SCTs-NOS have malignant potential, and the treatments for patients with malignant tumors and disease recurrence or progression were cytoreductive surgery, adjuvant chemotherapy, and gonadotrophin-releasing hormone agonists (GnRHa) therapy.
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Affiliation(s)
- Yue Sun
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Lina Tian
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Chao Meng
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
- Tianjin Key Laboratory of Female Reproductive Health and Eugenics, Tianjin Medical University General Hospital, Tianjin, China
| | - Guoyan Liu
- Department of Gynecologic Oncology, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Therapy of Tianjin, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Tianjin, China
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2
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Thayer MB, Sahraoui G, Abouda HS, Farhati M, Doghri R, Mrad K. Ovarian mass in a patient with invasive breast carcinoma: A case report of an unexpected diagnosis. Int J Surg Case Rep 2024; 117:109457. [PMID: 38471218 PMCID: PMC10945163 DOI: 10.1016/j.ijscr.2024.109457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/23/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
INTRODUCTION Ovarian steroid cell tumors not otherwise specified (OSCT-NOS) are extremely rare ovarian sex cord stromal tumors, accounting for <0.1 % of all ovarian tumors. In 25 % of cases, they are asymptomatic leading to a delay in diagnosis. We, herein, report a singular case of OSCT-NOS diagnosed incidentally during the spread assessment of an invasive breast carcinoma of no special type (IBC-NOS). To the best of our knowledge, this is the first reported case of co-occurrence of OSCT-NOS and IBC-NOS. We aim to study the clinic-pathological characteristics of this rare tumor. CASE PRESENTATION A 56-years old postmenopausal female, with no previous medical history, was diagnosed with an invasive IBC-NOS. The tomography performed during the spread assessment of IBC-NOS showed a suspicious mass of the right ovary. Pelvic MRI revealed an ovarian solid T1 isointense and T2 hyperintense mass. The first evoked diagnosis was an ovarian metastasis of the IBC-NOS. The patient underwent bilateral salpingo-oophorectomy. On gross examination, an ovarian solid mass measuring 2,5x2cm, with a firm gray yellowish cut surface was noted. Microscopic examination and immunostaining concluded to OSCT-NOS and ruled out the diagnosis of an ovarian metastasis of IBC-NOS. CONCLUSION OSCT-NOS are rare neoplasms. Their diagnosis might be challenging especially in absence of hormonal symptoms. A better knowledge of this rare entities would enable early diagnosis.
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Affiliation(s)
- Maissa Ben Thayer
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia; Salah Azaïez's Institute, Department of Pathology, Tunis, Tunisia.
| | - Ghada Sahraoui
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia; Salah Azaïez's Institute, Department of Pathology, Tunis, Tunisia
| | | | - Mahdi Farhati
- C Unit, Tunis Maternity and Neonatology Center, Tunis, Tunisia
| | - Raoudha Doghri
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia; Salah Azaïez's Institute, Department of Pathology, Tunis, Tunisia
| | - Karima Mrad
- Tunis El Manar University, Faculty of Medicine of Tunis, Tunis, Tunisia; Salah Azaïez's Institute, Department of Pathology, Tunis, Tunisia
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3
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Asa SL, Ezzat S. Endocrine tumors of the female reproductive tract. Mol Cell Endocrinol 2024; 582:112123. [PMID: 38135144 DOI: 10.1016/j.mce.2023.112123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
Endocrine cells responsible for hormone secretion are found in virtually every organ system. The diverse neoplasms arising from endocrine cells in the female reproductive tract are not well recognized as a distinct component of endocrine oncology. Here, we integrate cellular origins with native anatomical residence to help classify neoplasms of this system. The neoplasms include steroidogenic tumors that arise usually in ovarian stroma, neuroendocrine neoplasms that can arise from normal neuroendocrine cells throughout the female reproductive tract or in ovarian germ cell tumors, and thyroid follicular cell proliferations that are exclusively a component of an ovarian teratoma and may be malignant. The neuroendocrine neoplasms run the full spectrum from indolent neuroendocrine tumors to aggressive poorly differentiated neuroendocrine carcinomas. While many of these lesions are identified as incidental findings in surgically resected tissues, others present with inappropriate hormone excess. An important consideration is the distinction of primary disease from metastatic malignancy. Genetic disorders including those caused by germline mutations of the FOXL2, GNAS, DICER1, STK11 and MEN1 genes can present with primary endocrine neoplasms of the female reproductive tract.
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Affiliation(s)
- Sylvia L Asa
- Department of Pathology, University Hospitals Cleveland Medical Center, Case Western Reserve University, United States.
| | - Shereen Ezzat
- Department of Medicine, Endocrine Oncology, Princess Margaret Hospital, University Health Network, University of Toronto, United States
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4
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Punneshetty S, Sebastian A, Thomas V, Daniel S, Briskala P, Singh A, Thomas A. Malignant Metastatic Steroid Cell Tumor NOS: A rare presentation of a subtype of sex cord stromal tumor. Gynecol Oncol Rep 2023; 46:101169. [PMID: 37082522 PMCID: PMC10111942 DOI: 10.1016/j.gore.2023.101169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/27/2023] [Accepted: 03/20/2023] [Indexed: 03/31/2023] Open
Abstract
Steroid cell tumors - not otherwise specified (NOS) - are rare sex cord stromal tumors that lack characteristic histology, are benign, and usually present with androgenic manifestations. Metastatic malignant steroid cell tumors pose treatment challenges due to their chemoresistance nature. This is a case report of a metastatic steroid cell tumor - NOS with extensive peritoneal disease.
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5
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Lin M, Bao K, Lu L, Xu S, Liang Y, Cheng X, Wang F. Ovarian steroid cell tumors, not otherwise specified: analysis of nine cases with a literature review. BMC Endocr Disord 2022; 22:265. [PMID: 36316664 PMCID: PMC9623933 DOI: 10.1186/s12902-022-01170-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Accepted: 09/27/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS), are rare, with few large studies. The purpose of this study was to analyze the clinical features, prognosis, and treatment choices for these patients of different age groups. METHODS This was a retrospective study. We identified nine cases of ovarian steroid cell tumor, not otherwise specified, confirmed by post-operative histopathological examination, and analyzed clinical features, surgical procedures, and follow up outcomes. We also reviewed cases reports of ovarian steroid cell tumors, not otherwise specified. RESULTS A total of nine cases were included. The age range was 9-68 years (mean, 41.89 ± 19.72 years). Clinical features included virilization, amenorrhea, abdominal pain, vaginal bleeding, isosexual precocious puberty, Cushing's syndrome, and abnormal weight gain with elevated testosterone levels. The follow up interval ranged 5-53 months and no recurrence was observed. CONCLUSION Ovarian steroid cell tumors covered all age groups, with manifestations of androgen excess. Younger patients appeared to have a more favorable prognosis, which provided more opportunities for these patients to pursue treatment options that will preserve reproductive function.
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Affiliation(s)
- Mengyan Lin
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Kechun Bao
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Lingjia Lu
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Shuhang Xu
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Yun Liang
- Department of Pathology, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xiaodong Cheng
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China
| | - Fenfen Wang
- Department of Gynecological Oncology, Women's Hospital, Zhejiang University School of Medicine, No.1 Xueshi Road, 310006, Hangzhou, Zhejiang Province, China.
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6
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A Report of a Case With Pediatric Ovarian Steroid Cell Tumor, Not Otherwise Specified, Found With Precocious Puberty. J Pediatr Hematol Oncol 2022; 45:e522-e524. [PMID: 35700385 DOI: 10.1097/mph.0000000000002496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 11/26/2022]
Abstract
A 4-year-old girl was admitted to our hospital because of precocious puberty. Radiologic findings revealed a fist-sized solid tumor in the left ovary without ascites, peritoneal dissemination, and distant metastasis. The patient underwent left salpingo-oophorectomy without spillage. The size of the excised tumor was 10.0×9.0×4.8 cm. On pathologic examination, the tumor was diagnosed as an ovarian steroid cell tumor, not otherwise specified. In the present case, although the diameter of the tumor (>7 cm) and three mitoses per 10 high-power fields represented some potential for malignancy, we opted for careful observation without chemotherapy as the tumor was of clinical stage Ia.
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7
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Vasilevska D, Rudaitis V, Vasilevska D, Mickys U, Wawrysiuk S, Semczuk A. Failure of multiple surgical procedures and adjuvant chemotherapy in early-stage steroid-cell ovarian tumor treatment: a case report and literature review. J Int Med Res 2021; 49:300060520983195. [PMID: 33435776 PMCID: PMC7809311 DOI: 10.1177/0300060520983195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Ovarian steroid-cell tumors (SCTs) are a rare subgroup of sex-cord tumors of the ovary, accounting for less than 0.1% of all ovarian tumors. Not otherwise specified (NOS) tumors are the most common subtype. More than half of patients with SCTs-NOS show hyperandrogenic symptoms. The primary treatment for SCTs is surgery, as most cases are early-staged and benign. Because of the low incidence of metastatic disease, there is insufficient reliable information on the role of adjuvant therapy and the most effective treatment regimen. In this report, a rare case of a recurrent SCT-NOS in a 36-year-old female patient without endocrine symptoms is presented, highlighting the significance of appropriate pathological evaluation and immunohistochemical testing for the accurate diagnosis of this malignancy, particularly in the case of hormonally “silent” tumors. The metastatic tumor described here showed no response to four courses of adjuvant chemotherapy after several debulking surgeries. Based on the clinical findings, the neoplastic etiology should always be considered during the resection of ovarian tumors to prevent possible disease dissemination due to inappropriate surgical techniques.
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Affiliation(s)
- Danuta Vasilevska
- Vilnius University Hospital Santaros Clinics, Department of Gynecology, Vilnius, Lithuania
| | | | | | - Ugnius Mickys
- Vilnius University Hospital Santaros Clinics, National Centre of Pathology, Vilnius, Lithuania
| | - Sara Wawrysiuk
- 2nd Department of Gynecology, Lublin Medical University, Lublin, Poland
| | - Andrzej Semczuk
- 2nd Department of Gynecology, Lublin Medical University, Lublin, Poland
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8
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Hamdy O, Saleh GA, Eldegwi SA, Elsayed M, Metwally IH, Naguib R, Setit A. Multicentric adrenocorticotropic hormone -producing steroid cell tumor of the fallopian tube & broad ligament in a 15 year old girl. Gynecol Endocrinol 2020; 36:835-838. [PMID: 32091276 DOI: 10.1080/09513590.2020.1731451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Steroid cell tumors occur usually in the ovaries with very few reported cases of extra-ovarian origin. Our patient was a fifteen year old female, complaining from secondary amenorrhea and voice deepening. Values of serum cortisol, DHEA, FSH & LH were normal. Serum Testosterone was elevated while ACTH-pm was markedly elevated. MRI described bilateral solid para-ovarian masses. Exploration revealed two bilateral tubal extraluminal cysts & a right broad ligament cyst which were all excised. Pathological examination led to the diagnosis of steroid cell tumor. Serum testosterone & ACTH returned to normal levels after surgery with subsequent regression of the virilizing symptoms. We can conclude that extra-ovarian steroid cell tumors are extremely rare. They are usually presented with virilizing symptoms and hormonal abnormalities. Surgery is the main line of treatment.
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Affiliation(s)
- Omar Hamdy
- Surgical Oncology unit, Oncology center, Mansoura University, Mansoura, Egypt
| | - Gehad A Saleh
- Radiology department, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Sara A Eldegwi
- Pathology department, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Mohammed Elsayed
- Endocrinology unit, Specialized medical hospital, Mansoura University, Mansoura, Egypt
| | - Islam H Metwally
- Surgical Oncology unit, Oncology center, Mansoura University, Mansoura, Egypt
| | - Reham Naguib
- Pathology department, Faculty of medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Setit
- Surgical Oncology unit, Oncology center, Mansoura University, Mansoura, Egypt
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9
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Szeliga A, Zysnarska A, Podfigurna A, Maciejewska-Jeske M, Moszyński R, Sajdak S, Jasiński P, Frankowski A, Genazzani AR, Męczekalski B. Ovarian steroid cell tumor as an example of severe hyperandrogenism in 45-year-old woman. Gynecol Endocrinol 2020; 36:303-307. [PMID: 31718336 DOI: 10.1080/09513590.2019.1689551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Approximately, 5% of ovarian tumors have hormonal activity. Steroid cell tumors (SCTs) represent about 0.1% of all ovarian tumors. They cause hyperandrogenism associated with typical virilization. In this case report, we present 45-year-old women with unmalignant ovarian SCT-producing androgens which cause severe virilization and secondary amenorrhea lasting two years. Transvaginal ultrasound, computed tomography of adrenal glands, magnetic resonance imaging of small pelvis, laboratory tests (including serum concentration of FSH, LH, testosterone (T), androstenedione (A), dehydroepiandrosterone sulfate (DHEA-S), as well as ROMA index) were performed. During hormonal evaluation, elevated concentrations of serum T - on admission 1.72 ng/ml and one month later 3.75 ng/ml (normal range 0.08-0.82 ng/ml) and A - 24.90 ng/ml (normal range 0.40-3.40 ng/ml) were found. The ROMA index was within the normal range. Enlargement of the left ovary by solid mass 56 × 43 mm was found during ultrasound examination. Based on small pelvis MRI scan and hormonal finding, patient was qualified for laparotomy. During this procedure, the left salpingo-oophorectomy with removal of the tumor was performed. The histopathological examination identified SCT. During follow-up examination, one day after surgery, we found serum testosterone levels within normal ranges - 0.74 ng/ml (normal range 0.08-0.82 ng/ml). This case shows that hormone-producing ovarian tumors are rare but very important clinical causes of severe hyperandrogenism.
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Affiliation(s)
- Anna Szeliga
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Aleksandra Zysnarska
- Students Scientific Society of the Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | - Agnieszka Podfigurna
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
| | | | - Rafał Moszyński
- Division of Gynecological Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Stefan Sajdak
- Division of Gynecological Surgery, Poznan University of Medical Sciences, Poznan, Poland
| | - Piotr Jasiński
- Department of Pathology, Gynecological and Obstetric Clinical Hospital in Poznan, Poznan, Poland
| | - Andrzej Frankowski
- Department of Pathology, Gynecological and Obstetric Clinical Hospital in Poznan, Poznan, Poland
| | - Andrea R Genazzani
- Department of Reproductive Medicine and Child Development, Division of Gynecology and Obstetrics, University of Pisa, Pisa, Italy
| | - Błażej Męczekalski
- Department of Gynecological Endocrinology, Poznan University of Medical Sciences, Poznan, Poland
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10
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A Rare Case of Steroid Cell Tumor, Not Otherwise Specified (NOS), of the Ovary in a Young Woman. Case Rep Obstet Gynecol 2019; 2019:4375839. [PMID: 31428489 PMCID: PMC6683816 DOI: 10.1155/2019/4375839] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 07/08/2019] [Indexed: 11/30/2022] Open
Abstract
Steroid cell tumour is a rare sex cord-stromal tumor of the ovary. It may produce steroids and is associated with testosterone secretion which causes symptoms like hair loss, hirsutism, and oligomenorrhea/amenorrhea due to hormonal activity and virilizing properties of tumor. In this article, we reported a 27-year-old woman who presented with hirsutism, hoarseness of voice, scalp hair fall, and amenorrhea for 8 years. Clinical and diagnostic evaluation revealed a left adnexal mass and elevated serum levels of testosterone and she was diagnosed as having a Sertoli Leydig cell tumour of ovary. She underwent left salpingooophorectomy and both histopathological examination and immunohistochemistry confirmed the diagnosis. Her serum testosterone levels normalized 3 days after the surgery and her menses resumed spontaneously a few months after the operation. In addition, we reviewed the literature on the epidemiology, clinical presentations, imaging and histological findings, and the treatment options on this disease.
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11
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Yuan X, Sun Y, Jin Y, Chen X, Wang X, Ji T, Wang C, Dai H. Ovarian steroid cell tumor, not otherwise specified, treated with surgery: a case report and review of literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2019; 12:1434-1438. [PMID: 31933961 PMCID: PMC6947056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Accepted: 02/22/2019] [Indexed: 06/10/2023]
Abstract
Ovarian steroid cell tumors NOS are rare sex cord-stromal tumors. They account for less than 0.1% of ovarian tumors. We present a case of a 17-year-old girl with the complaint of amenorrhea. The serum testosterone level was 11.55 nmol/L (reference value, 0.35-2.6 nmol/L) and the serum value of dehydroepiandrosterone-sulfate (DHEA-S) was 5.9 μmol/L (reference value, 0.49-8.71 μmol/L). A computed tomography (CT) pelvic scan identified a solid, right ovarian tumor and detected no adrenal gland enlargement or additional tumors. We took a surgical excision and a wedge resection of the normal contralateral ovary. The histopathologic examination on microscopy confirmed it was a benign ovarian steroid cell tumor NOS. Four days postoperative, her sex hormones were declined to normal levels and her serum testosterone level was 2.37 nmol/L (reference value, 0.35-2.6 nmol/L) a month after surgery. Her serum testosterone level was in the normal range and there was no evidence of recurrence 6 months after surgery.
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Affiliation(s)
- Xiong Yuan
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Ying Sun
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Yichao Jin
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Xing Chen
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Xiuli Wang
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Tonghui Ji
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Cong Wang
- Department of Pathology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
| | - Huihua Dai
- Department of Gynecology, The First Affiliated Hospital with Nanjing Medical UniversityNanjing 210000, Jiangsu, China
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Taba T, Nandwani M, Barmon D, Kataki AC. A Rare Case of Concurrent Steroid Cell Tumor of Ovary with Struma Ovarii. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0191-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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13
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Alshaikh OM, Laframboise S, Asa SL, Clarke B, Mete O, Ezzat S. Malignant Ovarian Steroid Cell Tumor Causing Severe Hyperandrogenism: Case Report And Review Of The Literature. AACE Clin Case Rep 2017. [DOI: 10.4158/ep161685.cr] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Sedhom R, Hu S, Ohri A, Infantino D, Lubitz S. Symptomatic Cushing's syndrome and hyperandrogenemia in a steroid cell ovarian neoplasm: a case report. J Med Case Rep 2016; 10:278. [PMID: 27729065 PMCID: PMC5059940 DOI: 10.1186/s13256-016-1061-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 09/09/2016] [Indexed: 11/23/2022] Open
Abstract
Background Malignant steroid cell tumors of the ovary are rare and frequently associated with hormonal abnormalities. There are no guidelines on how to treat rapidly progressive Cushing’s syndrome, a medical emergency. Case presentation A 67-year-old white woman presented to our hospital with rapidly developing signs and symptoms of Cushing’s syndrome secondary to a steroid-secreting tumor. Her physical and biochemical manifestations of Cushing’s syndrome progressed, and she was not amenable to undergoing conventional chemotherapy secondary to the debilitating effects of high cortisol. Her rapidly progressive Cushing’s syndrome ultimately led to her death, despite aggressive medical management with spironolactone, ketoconazole, mitotane, and mifepristone. Conclusions We report an unusual and rare case of Cushing’s syndrome secondary to a malignant steroid cell tumor of the ovary. The case is highlighted to discuss the complications of rapidly progressive Cushing’s syndrome, an underreported and often unrecognized endocrine emergency, and the best available evidence for treatment.
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Affiliation(s)
- Ramy Sedhom
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA.
| | - Sophia Hu
- Department of Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Anupam Ohri
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Dorian Infantino
- Department of Pathology and Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
| | - Sara Lubitz
- Division of Endocrinology, Metabolism & Nutrition, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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15
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Sood N, Desai K, Chindris AM, Lewis J, Dinh TA. Symptomatic Ovarian Steroid Cell Tumor not Otherwise Specified in a Post-Menopausal Woman. Rare Tumors 2016; 8:6200. [PMID: 27441075 PMCID: PMC4935824 DOI: 10.4081/rt.2016.6200] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 12/09/2015] [Accepted: 12/16/2015] [Indexed: 12/18/2022] Open
Abstract
Steroid cell tumor not otherwise specified (NOS) is a rare subtype of sex cord stromal tumor of the ovary and contributes less than 0.1% of all ovarian neoplasms. The majority of tumors occur in pre-menopausal women (mean age: 43 years), in which 56-77% of patients present with virilization due to excess testosterone. An 80-year-old woman with worsening alopecia and excessive growth of coarse hair on abdomen and genital area was found to have elevated serum testosterone level (462 ng/mL). Radiologic studies were consistent with bilateral adrenal adenomas. Bilateral adrenal venous sampling ruled out the adrenal gland as origin of hormone secretion. A diagnostic and therapeutic bilateral salpingo-oophorectomy confirmed steroid cell tumor NOS of the left ovary. Post-operatively, the patient had complete resolution of her symptoms and normalization of testosterone level. Our case emphasizes the importance of a clinical suspicion for an occult testosterone secreting ovarian tumor in a symptomatic patient without obvious ovarian mass on imaging.
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Affiliation(s)
- Neha Sood
- Department of Medical and Surgical Gynecology
| | | | | | - Jason Lewis
- Department of Pathology, Mayo Clinic , Jacksonville, FL, USA
| | - Tri A Dinh
- Department of Medical and Surgical Gynecology
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Lambrinoudaki I, Dafnios N, Kondi-Pafiti A, Triantafyllou N, Karopoulou E, Papageorgiou A, Augoulea A, Armeni E, Creatsa M, Vlahos N. A case of postmenopausal androgen excess. Gynecol Endocrinol 2015; 31:760-4. [PMID: 26287476 DOI: 10.3109/09513590.2015.1075500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Ovarian steroid cell tumors are very rare but potentially life-threatening neoplasms. They represent less than 0.1% of all ovarian tumors, typically present in premenopausal women and frequently manifest with virilization. Signs of hyperandrogenism may appear in postmenopausal women due to tumorοus and non-tumorοus adrenal and ovarian causes as well due to the normal aging process. In any case, steroid cell tumor should be suspected in postmenopausal women who present with rapid progressive androgen excess symptoms. This report describes a case of a 67-year-old postmenopausal woman with signs of hyperandrogenism, where an ovarian steroid cell tumor was diagnosed and treated by laparoscopic bilateral salpingo-oophorectomy and synchronous hysterectomy.
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Affiliation(s)
| | - Nikos Dafnios
- b 2nd Department of Surgery , National and Kapodistrian University of Athens, Aretaieio Hospital , Athens , Greece , and
| | | | - Nikos Triantafyllou
- c First Neurology Department , National and Kapodistrian University of Athens, Aiginiteion Hospital , Athens , Greece
| | | | | | | | - Eleni Armeni
- a 2nd Department of Obstetrics and Gynecology and
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Haroon S, Idrees R, Fatima S, Memon A, Kayani N. Ovarian steroid cell tumor, not otherwise specified: a clinicopathological and immunohistochemical experience of 12 cases. J Obstet Gynaecol Res 2014; 41:424-31. [PMID: 25345475 DOI: 10.1111/jog.12537] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/10/2014] [Indexed: 11/28/2022]
Abstract
AIM Ovarian steroid cell tumors, not otherwise specified (SCT-NOS) are very rare neoplasms. No large study has been performed in Pakistan to establish the clinicopathological spectrum and immunohistochemical behavior in our region. The purpose of our study was to determine the various clinicopathological and immunohistochemical features of ovarian SCT-NOS along with follow-up in our institution. METHODS This was a retrospective observational study. The study was conducted in the Section of Histopathology, Aga Khan University Hospital, Karachi, Pakistan. All reported cases of ovarian SCT-NOS occurring during January 1992 to August 2013 were retrieved. The slides were reviewed and patient demographics, and clinical and pathological features were noted with proforma software. SPSS version 19 was used for all analyses. Data is expressed as absolute values and percentages. RESULTS A total of 12 SCT-NOS (2.3%) out of 528 ovarian sex cord stromal tumors were retrieved. The age range was 3-70 years, with mean of 40.75 years. The tumors ranged 2.5-13 cm in size, with a mean size of 6.1 cm. One patient had bilateral tumors. All of the tumors were positive for inhibin and calretinin. Four tumors were negative for Mic-2 (CD99). In two patients, the tumor recurred. Only one patient who had worse pathological features received adjuvant chemotherapy. CONCLUSION Steroid cell tumors are very rare ovarian tumors in the Pakistani population, mostly presenting in adulthood. Diverse histological differentials exist so special stains and immunohistochemical stains are needed to distinguish these from other tumors.
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Affiliation(s)
- Saroona Haroon
- Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan
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Wan J, Chen X, Li X. Ovarian steroid cell tumor, not otherwise specified: A rare case of postmenopausal vaginal bleeding. Oncol Lett 2014; 8:1187-1189. [PMID: 25120684 PMCID: PMC4114601 DOI: 10.3892/ol.2014.2251] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Accepted: 03/20/2014] [Indexed: 12/11/2022] Open
Abstract
Ovarian steroid cell tumors (SCTs), not otherwise specified (NOS) are particularly rare ovarian tumors, which are composed of steroid-hormone secreting cells. The majority of patients with this tumor produce excessive quantities of testosterone and virilization is common. The current report presents a rare case of SCT in a 59-year-old female who presented with postmenopausal vaginal bleeding. The patient had experienced irregular vaginal bleeding for two months, 12 years after menopause. Transvaginal ultrasound and magnetic resonance imaging identified a solid adnexal mass and the pathological result of diagnostic curettage showed a proliferative endometrium. The patient’s serum estrogen and testosterone levels were elevated (393.71 nmol/l and 22.28 nmol/l, respectively). The patient underwent an exploratory laparotomy, hysterectomy and bisalpingectomy. The neoplasm was well-circumscribed, solid, homogeneous and yellow in color. Microscopically, the tumor was predominantly composed of granular eosinophilic or vacuolated cytoplasm. Reinke’s crystals, prominent nucleoli and Call-Exner bodies were not observed, and there was no mitotic figure. Immunohistochemistry demonstrated that the tumor cells were strongly positive for inhibin. The present rare case aims to expand the current knowledge of this type of ovarian tumor.
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Affiliation(s)
- Jing Wan
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Xiaowei Chen
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
| | - Xiaomao Li
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong 510630, P.R. China
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Li K, Zhu F, Xiong J, Liu F. A rare occurrence of a malignant ovarian steroid cell tumor not otherwise specified: A case report and literature review. Oncol Lett 2014; 8:770-774. [PMID: 25009655 PMCID: PMC4081424 DOI: 10.3892/ol.2014.2233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/13/2014] [Indexed: 12/11/2022] Open
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.
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Affiliation(s)
- Kai Li
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Fufan Zhu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Jing Xiong
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Fengying Liu
- Department of Obstetrics and Gynecology, The Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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20
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Tai YJ, Chang WC, Kuo KT, Sheu BC. Ovarian steroid cell tumor, not otherwise specified, with virilization symptoms. Taiwan J Obstet Gynecol 2014; 53:260-2. [DOI: 10.1016/j.tjog.2013.04.037] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 10/25/2022] Open
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Chung DH, Lee SH, Lee KB. A case of ovarian steroid cell tumor, not otherwise specified, treated with surgery and gonadotropin releasing hormone agonist. J Menopausal Med 2014; 20:39-42. [PMID: 25371891 PMCID: PMC4217570 DOI: 10.6118/jmm.2014.20.1.39] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Revised: 02/11/2014] [Accepted: 02/11/2014] [Indexed: 12/03/2022] Open
Abstract
Steroid cell tumors account for less than 0.1% of all ovarian tumors. There are three steroid cell tumor subtypes: steroid cell tumor not otherwise specified (NOS), stromal luteoma and Leydig cell tumor. Steroid cell tumor, NOS, is the most common type and has malignant potential. This report describes a case of an ovarian steroid cell tumor, NOS. A 35-year-old woman visited hospital with the complaint of metrorrhagia. Physical examination revealed increased pubic hair. Transvaginal ultrasound indentified a 4.9 × 3.4 cm, well-circumscribed and solid left ovarian tumor. After laparoscopic left oophorectomy, the tumor was revealed as an ovarian steroid cell tumor, NOS. During the laparoscopic surgery, tumor ruptured. Complete surgical staging was performed and no evidence of metastasis was found. Gonadotropin releasing hormone agonist was administered monthly for 6 months. The patient has had no evidence of recurrence for 43 months.
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Affiliation(s)
- Dong-Hae Chung
- Department of Pathology, Gachon University Gil Medical Center, Incheon, Korea
| | - Seung-Ho Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
| | - Kwang-Beom Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Medical Center, Incheon, Korea
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22
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Yuan M, Qiu M, Zhu M. Symptomatic Cushing syndrome and hyperandrogenemia revealing steroid cell ovarian neoplasm with late intra-abdominal metastasis. BMC Endocr Disord 2014; 14:12. [PMID: 24506845 PMCID: PMC3930759 DOI: 10.1186/1472-6823-14-12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 02/07/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Steroid cell tumors of ovary account for less than 0.1% of all ovarian tumors and these tumours may present at any age in association with interesting presentations related to hormonal activities. The subtype, not otherwise specified (NOS), is associated with androgenic changes in 56-77% and Cushing syndrome in 6-10%. Due to the rarity of available data regarding these tumors, little is known about their malignant potential and metastatic behaviour. We hereby report an unusual metastasis of steroid cell ovarian neoplasm presented with both Cushing syndrome and hyperandrogenemia. CASE PRESENTATION A 31-year-old woman, who had a past medical history of ovarian tumor resection (left ovarian thecoma was initially diagnosed at that time), presented with hirsutism, hypertension and menstrual disorder. Also, laboratory work-up revealed hypercortisolism and androgen excess. Computerized tomography (CT) of the abdomen showed abdominal paraaortic masses, multiple intrahepatic nodules and retroperitoneal lymph nodes enlargement. Positron emission tomography/computed tomography (PET/CT) scan demonstrated metastatic lesions. Her ovarian tumor sections were re-examined and pathology result was corrected to steroid cell tumor (NOS) associated with active cell growth and necrosis. Subsequent excision of metastatic lesions yielded clinical improvement promptly and metastasis of steroid cell tumor was confirmed by postoperative pathological studies. However, one year after the surgical management of metastasis, recurrence happened while radiotherapy was ineffective. The patient finally died of tumor metastatic recurrence. CONCLUSION This case reports a rare coexistence of Cushing syndrome and hyperandrogenemia which occurs based on metastasis of steroid cell ovarian neoplasm. It presents a real diagnostic challenge to both clinicians and pathologists. Therefore, it is very important to establish a final diagnosis by pathological studies along with clinical manifestations and imaging findings. Besides, it is necessary to improve follow-up of patients with this kind of tumors.
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Affiliation(s)
- Menghua Yuan
- Postal address: Department of Endocrinology, General Hospital of Tianjin Medical University, NO. 154 Anshan Road, Heiping District, Tianjin 300052, China
| | - Mingcai Qiu
- Postal address: Department of Endocrinology, General Hospital of Tianjin Medical University, NO. 154 Anshan Road, Heiping District, Tianjin 300052, China
| | - Mei Zhu
- Postal address: Department of Endocrinology, General Hospital of Tianjin Medical University, NO. 154 Anshan Road, Heiping District, Tianjin 300052, China
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Oz M, Ozgü E, Türker M, Erkaya S, Güngör T. Steroid cell tumor of the ovary in a pregnant woman whose androgenic symptoms were masked by pregnancy. Arch Gynecol Obstet 2014; 290:131-4. [PMID: 24488584 DOI: 10.1007/s00404-014-3165-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 01/16/2014] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Ovarian steroid cell tumors are very rare sex cord-stromal tumors, and most of them are unilateral and almost one-third of the cases are malignant. CASE REPORT Here, we present a pregnant woman, who diagnosed with steroid cell tumor of the ovary and underwent surgical staging. DISCUSSION We will discuss the clinical presentation of the case, management options and follow-up strategies.
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Affiliation(s)
- Murat Oz
- Department of Gynaecological Oncology, Zekai Tahir Burak Women's Health Hospital, Talatpasa Blv. Altindag, Ankara, Turkey,
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Right ovarian steroid tumor (not otherwise specified). Ultrasound Q 2013; 29:227-9. [PMID: 23945488 DOI: 10.1097/ruq.0b013e3182a1b8f8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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25
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Jiang W, Tao X, Fang F, Zhang S, Xu C. Benign and malignant ovarian steroid cell tumors, not otherwise specified: case studies, comparison, and review of the literature. J Ovarian Res 2013; 6:53. [PMID: 23870399 PMCID: PMC3724598 DOI: 10.1186/1757-2215-6-53] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 07/18/2013] [Indexed: 11/10/2022] Open
Abstract
Ovarian steroid cell tumors, not otherwise specified (NOS) are rare sex cord-stromal tumors of the ovary with malignant potential. So far only a few cases were reported in English literature through the Pubmed search. Here we report two cases of such tumor, one was benign (first case underwent laparoscopic cystectomy) and the other was malignant (died 10 months later after initial diagnosis), both presented with amenorrhea and clinical signs or symptoms of virilization. In malignant case, we provided evidence (tumor embolus) in addition to the reported five characteristics associated with malignancy. On further evaluation, laboratory investigations revealed hyperandrogenism in the male range, while follicle stimulating hormone (FSH) and luteinising hormone (LH) levels were within normal limits. Various aspects of the presentation, diagnosis, and treatment of these tumors are discussed.
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Affiliation(s)
- Wei Jiang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, P. R. China ; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China
| | - Xiang Tao
- Department of Pathology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Fang Fang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, P. R. China
| | - Shaofen Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, P. R. China
| | - Congjian Xu
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, 419 Fangxie Road, Shanghai 200011, P. R. China ; Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, People's Republic of China
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An asymptomatic ovarian steroid cell tumor with complete cystic morphology: A case report. Obstet Gynecol Sci 2013; 56:50-5. [PMID: 24327981 PMCID: PMC3784108 DOI: 10.5468/ogs.2013.56.1.50] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Revised: 10/13/2012] [Accepted: 10/13/2012] [Indexed: 12/15/2022] Open
Abstract
Steroid cell tumors of the ovary are extremely rare, accounting for only 0.1% of all ovarian tumors. Of these, steroid cell tumors, not otherwise specified (NOS) constitute about 56% of all steroid cell tumors. Most steroid cell tumors secrete steroid hormones, and only about 10% to 15% of patients are asymptomatic. The morphology of steroid cell tumors, NOS is predominantly reported to be solid, and a review of case reports from 1979 until now revealed only 5 cases that were mainly cystic tumors. The present case, in a patient who had undergone a previous hysterectomy and surgery for a peritoneal inclusion cyst, is reported due to its rarity and its unusual presentation, together with a brief review of the literature. The tumor showed no clinical signs and symptoms typical of a steroid hormone secreting tumor and had an atypical morphology, being primarily multi-septate cystic with a minor solid portion.
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Tandon R, Goel P, Kataria S, Saha PK, Punia RPS, Dimri K. Paraneoplastic erythrocytosis in a malignant ovarian steroid cell tumour. Indian J Hematol Blood Transfus 2012; 30:54-5. [PMID: 24554825 DOI: 10.1007/s12288-012-0193-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 08/31/2012] [Indexed: 10/27/2022] Open
Abstract
Neoplastic polycythemia is a condition in which high hematocrit levels result from a neoplastic lesion in the body. It is a rare condition and occur because of excess erythropoietin or androgen production by the neoplastic cells. Steroid cell tumours of the ovary though notorious for producing endocrine changes in the body have rarely been associated with polycythemia. We present the case of a post menopausal lady who developed polycythemia and features of virilisation. Further investigations revealed that she had steroid cell tumour of the left ovary. Her signs and symptoms resolved after surgical removal of the tumour.
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Affiliation(s)
- Rimpy Tandon
- Department of Obstetrics & Gynaecology, Government Medical College & Hospital, Sector 32, Chandigarh, 160030 India
| | - Poonam Goel
- Department of Obstetrics & Gynaecology, Government Medical College & Hospital, Sector 32, Chandigarh, 160030 India
| | - Shailja Kataria
- Department of Obstetrics & Gynaecology, Government Medical College & Hospital, Sector 32, Chandigarh, 160030 India
| | - Pradip Kumar Saha
- Department of Obstetrics & Gynaecology, Government Medical College & Hospital, Sector 32, Chandigarh, 160030 India
| | - R P S Punia
- Department of Histopathology, Government Medical College & Hospital, Sector 32, Chandigarh, 160030 India
| | - Kislay Dimri
- Department of Radiotherapy, Government Medical College & Hospital, Sector 32, Chandigarh, 160030 India
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Lee SH, Kang MS, Lee GS, Chung WY. Refractory hypertension and isosexual pseudoprecocious puberty associated with renin-secreting ovarian steroid cell tumor in a girl. J Korean Med Sci 2011; 26:836-8. [PMID: 21655074 PMCID: PMC3102882 DOI: 10.3346/jkms.2011.26.6.836] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 02/28/2011] [Indexed: 11/20/2022] Open
Abstract
Steroid cell tumor, not otherwise specified (NOS), are rare ovarian tumor, in addition, it is more rare in children. The majority of these tumors produce several steroid hormones, particularly testosterone. Estrogen also secreted by steroid cell tumor, NOS, but it is uncommon. Furthermore, hypertension is an infrequent sign in steroid cell tumor, NOS. An 8.5-yr-old girl with hypertension and frequent vaginal spotting visited at our clinic. On laboratory evaluation, secondary hypertension due to an elevated plasma renin level and isosexual pseudoprecocious puberty was diagnosed. Right solid ovarian mass was detected in radiologic tests. She underwent a right ooporectomy and it revealed renin and progesterone receptor positive steroid cell tumor, NOS. After operation, her blood pressure returned to normal level and vaginal bleeding disappeared. Even though this case is very rare, when hypertension coincides with virilization or feminization, a renin-secreting ovarian steroid cell tumor, NOS, should be considered.
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Affiliation(s)
- Sun Hee Lee
- Department of Pediatrics, College of Medicine, Inje University, Busan, Korea
| | - Mi Seon Kang
- Department of Pathology, College of Medicine, Inje University, Busan, Korea
| | - Gyeong Sin Lee
- Department of Pathology, Dong-eui Medical Center, Busan, Korea
| | - Woo Yeong Chung
- Department of Pediatrics, College of Medicine, Inje University, Busan, Korea
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Varras M, Vasilakaki T, Skafida E, Akrivis C. Clinical, ultrasonographic, computed tomography and histopathological manifestations of ovarian steroid cell tumour, not otherwise specified: our experience of a rare case with female virilisation and review of the literature. Gynecol Endocrinol 2011; 27:412-8. [PMID: 20586551 DOI: 10.3109/09513590.2010.495432] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Ovarian steroid cell tumours, not otherwise specified (NOS) are rare sex cord-stromal tumours of the ovary. These tumours should be considered a cause of isosexual precocious puberty in children and virilisation in adults. CASE We report a case of 40-year-old woman with mental handicap who presented with 3 years of amenorrhea and progressive virilisation. Pelvic ultrasonography identified a 6.19 × 6.15 cm well-defined echogenic-multilobular mass arising from the left ovary. Fluid in the cul-de-sac was noted. Colour Doppler examination with endovaginal ultrasonography showed high vascularity of the tumour with low resistance to flow. A computed tomography (CT) scan of the upper and lower abdomen showed a lobular mass with diaphragms in the left adnexal structure and fluid in the cul-de-sac; no adrenal gland enlargement or additional tumour was detected. Laboratory analysis revealed increased levels of serum total testosterone. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. Histological examination showed a benign steroid cell tumour, NOS without evidence of necrosis, haemorrhage or invasion. The immunohistochemical study showed that the tumour cells were positive for inhibin, CD 99, Melan A and vimentin and negative to CK AE1, CK AE3, progesterone and estrogen receptors. CONCLUSION Careful medical history, physical examination, laboratory serum values and imaging studies are helpful in making the pre-operative diagnosis. Steroid cell tumours, NOS are usually benign, unilateral and characterised by the composition of two similar-appearing polygonal cell types. They differ from Leydig cell tumours in the lack of crystals of Reinke in their cytoplasm.
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Affiliation(s)
- Michail Varras
- Department of Obstetrics and Gynecology, Tzaneio General State Hospital, Piraeus, Greece.
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Gupta P, Goyal S, Gonzalez-Mendoza LE, Noviski N, Vezmar M, Brathwaite CD, Misra M. Corticotropin-independent cushing syndrome in a child with an ovarian tumor misdiagnosed as nonclassic congenital adrenal hyperplasia. Endocr Pract 2009; 14:875-9. [PMID: 18996816 DOI: 10.4158/ep.14.7.875] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To describe a patient with corticotropin-independent Cushing syndrome previously diagnosed and treated as congenital adrenal hyperplasia (CAH). METHODS We describe the initial manifestations, clinical investigations, and postoperative follow-up of the patient and review similar cases in the literature. RESULTS A 5 and 9/12-year-old girl who was initially diagnosed and treated as having CAH and was noncompliant with glucocorticoid therapy presented with weight gain, hypertension, and a mass in the lower abdomen. On physical examination, she was a cushingoid-appearing girl with proximal muscle weakness and notable facial acne. Laboratory findings included elevated serum testosterone, 17-hydroxyprogesterone, dehydroepiandrosterone sulfate, androstenedione, estradiol, and cortisol, as well as elevated urinary cortisol and cortisone. Serum corticotropin was undetectable. She had normal serum electrolytes and plasma renin activity. Computed tomography scan of the abdomen and pelvis showed a cystic mass with a focal enhancing solid component arising from the right ovary, which was subsequently determined to be a steroid cell tumor not otherwise specified. CONCLUSION Although ovarian steroid cell tumors typically secrete gonadal steroids, the rare steroid cell tumors not otherwise specified can secrete both glucocorticoids and gonadal steroids and are an unusual cause of Cushing syndrome.
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Affiliation(s)
- Punkaj Gupta
- Division of Pediatric Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Sawathiparnich P, Sitthinamsuwan P, Sanpakit K, Laohapensang M, Chuangsuwanich T. Cushing's syndrome caused by an ACTH-producing ovarian steroid cell tumor, NOS, in a prepubertal girl. Endocrine 2009; 35:132-5. [PMID: 19191036 DOI: 10.1007/s12020-009-9150-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2008] [Revised: 10/15/2008] [Accepted: 10/28/2008] [Indexed: 10/21/2022]
Abstract
Ectopic ACTH syndrome is a very rare cause of pediatric Cushing's syndrome. And if present, bronchial or thymic carcinoids predominate as causes. We hereby demonstrate a first case report of ACTH-producing ovarian steroid cell tumor, NOS, causing ectopic ACTH syndrome in a prepubertal girl.
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Affiliation(s)
- Pairunyar Sawathiparnich
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Al-Farsi A, Al-Talib A. Steroid cell tumor. Sultan Qaboos Univ Med J 2008; 8:358-359. [PMID: 21748086 PMCID: PMC3074846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2008] [Accepted: 07/25/2008] [Indexed: 05/31/2023] Open
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34
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Bibliography. Current world literature. Adrenal cortex. Curr Opin Endocrinol Diabetes Obes 2008; 15:284-299. [PMID: 18438178 DOI: 10.1097/med.0b013e3283040e80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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