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E-JCRT CORRESPONDENCE
Year : 2015  |  Volume : 11  |  Issue : 3  |  Page : 660

Steroid cell tumor: A rare virilizing ovarian tumor


Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong, Meghalaya, India

Date of Web Publication9-Oct-2015

Correspondence Address:
Ananya Das
Department of Obstetrics and Gynecology, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Mawdiangdiang, Shillong - 793 018, Meghalaya
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0973-1482.144364

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 > Abstract 

Steroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors. These tumors may present at any age with presentations related to the hormonal activity and virilizing properties of tumor. We present a case report of a young girl with ovarian steroid cell tumor, who had a complete and dramatic response to surgery alone.

Keywords: Ovarian tumor, steroid cell tumor, testosterone, virilization


How to cite this article:
Das A, Panda S, Singh A S. Steroid cell tumor: A rare virilizing ovarian tumor. J Can Res Ther 2015;11:660

How to cite this URL:
Das A, Panda S, Singh A S. Steroid cell tumor: A rare virilizing ovarian tumor. J Can Res Ther [serial online] 2015 [cited 2020 Jun 5];11:660. Available from: http://www.cancerjournal.net/text.asp?2015/11/3/660/144364


 > Introduction Top


Steroid cell tumors of the ovary account for less than 0.1% of all ovarian tumors. [1] These tumors may present at any age with presentations related to the hormonal activity and virilizing properties of tumor. The study by Hayes and Scully [2] reported 63 cases in patients ranging from 2 to 80 years of age. The subtype, not otherwise specified, is associated with androgenic changes in approximately one half of patients with this tumor. [1] Herein, we present a case report of a young girl with ovarian steroid cell tumor, who had a complete and dramatic response to surgery alone.


 > Case report Top


The present case report is about a 25-year-old unmarried girl attended gynecology out-patient department with virilizing symptoms and amenorrhea since 4 years. According to the patient, she was treated earlier with hormones, but there was no relief. She was obese, had hoarseness of voice and on examination, hirsutism and clittoromegaly was present. When we got her hormonal assay done, we could find that cortisol, dehydroepiandrosterone, thyroid profile, prolactin, follicle-stimulating hormone, luteinizing hormone were within the normal limit, except a high serum testosterone level of 4.01 ng/ml. Ultrasonography showed a solid right ovarian tumor of 3.5 × 3.9 cm. After all investigations, the decision for exploratory laparotomy was taken. On surgical staging laparotomy, it was found that there was an enlarged (4 × 5 × 5 cm) right ovary with both solid and cystic component with a smooth surface and normal ovarian contour. The left ovary was found normal. Right ovariectomy with salpingectomy and infracolic omentectomy was done and the specimen was sent for biopsy. On histopathological examination, sections showed large lipid laden cells with tiny cytoplasm at the extremities, surrounding stroma was edematous. Lesion was well-circumscribed and the features were suggestive of steroid cell tumor of the ovary, a very rare ovarian tumor. She had an uneventful recovery and was discharged after 5 days. At post-operative follow-up, the patient had regained normal menses after around 2 months. Her serum testosterone level had gone down to 0.262-ng/ml and there was a regression of the abnormal hair pattern. The patient is being followed-up regularly with hormonal assays.


 > Discussion Top


Ovarian steroid cell tumors are grouped under sex-chord stromal tumors and are usually benign, unilateral and characterized by a steroid cell proliferation. [1],[3] Steroid cell tumors are associated with androgenic changes with variable frequency, ranging from 12% to over 50% respectively. [1]

Historically these tumors have been variously referred to as lipoid cell tumors, lipid cell tumors, adrenal-like tumors, masculinovoblastomas, leutomas, hypernephroid tumors and adrenal rest tumors, indicating the infidelity of their supposed lineage [Figure 1]. [1],[2],[3]
Figure 1: Histopathology of steroid cell tumor

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The majority of steroid cell tumors have a benign or low-grade behavior. Interestingly, pathologically-benign tumors can behave in a clinically malignant fashion. [4] About 20% patients develop metastatic lesions usually within the peritoneal cavity and rarely at distant sites. [2],[5] In a series of 63 cases from the Massachusetts General Hospital, 94% of the tumors were found to be unilateral and 28.6% cases had features suggestive of malignant nature. [2]

The primary treatment is surgical extirpation of the primary lesion and there are no reports of effective radiation or chemotherapy. [6] In a young patient with stage IA disease, a unilateral salpingo-oophorectomy is adequate.

The main reason for poor understanding of the therapeutic value of chemotherapy and radiotherapy in the treatment of these tumors is due to the rarity of this tumor. In recent years attempts have been made to describe the use of gonadotrophin releasing hormone analogs to induce a suppression of secretions and an apoptosis leading to a non-surgical cure. [7],[8],[9]


 > Conclusion Top


This rare variety of virilizing ovarian tumor is not only a medical problem, but also a social problem to any age group woman. Here, surgery is the mainstay of treatment with dramatic response. Hence, early diagnosis and prompt treatment is the answer both medically and socially.

 
 > References Top

1.
Young RH, Shully RE. Steroid cell tumors of the ovary. In: Fox H, Wells M, editors. Obstetric and Gynecological Pathology. Spain: Churchill Livingstone; 2003. p. 845-56.  Back to cited text no. 1
    
2.
Hayes MC, Scully RE. Ovarian steroid cell tumors (not otherwise specified). A clinicopathological analysis of 63 cases. Am J Surg Pathol 1987;11:835-45.  Back to cited text no. 2
    
3.
Scully RE, Young RH, Clement PB. Steroid cell tumors. In: Tumors of the Ovary, Mal-developed Gonads, Fallopian Tube, and Broad Ligament. Washington, DC: Armed Forces Institute of Pathology; 1996. p. 227-38.  Back to cited text no. 3
    
4.
Clement PB, Young RH. Atlas of Gynecologic Surgical Pathology. Philadelphia, PA: WB Saunders Co.; 2000.  Back to cited text no. 4
    
5.
Barakat RR, Rubin SC, Wong G, Saigo PE, Markman M, Hoskins WJ. Mixed mesodermal tumor of the ovary: Analysis of prognostic factors in 31 cases. Obstet Gynecol 1992;80:660-4.  Back to cited text no. 5
    
6.
Karlan BY, Markman MA, Eifel PJ. Sex-cord stromal tumors. In: DeVita VT Jr, Hellman S, Rosenberg SA, editors. Cancer: Principles and Practice of Oncology. Philadelphia: Lippincott Williams and Wilkinson; 2005. p. 1392-3.  Back to cited text no. 6
    
7.
Pascale MM, Pugeat M, Roberts M, Rousset H, Déchaud H, Dutrieux-Berger N, et al. Androgen suppressive effect of GnRH agonist in ovarian hyperthecosis and virilizing tumours. Clin Endocrinol (Oxf) 1994;41:571-6.  Back to cited text no. 7
    
8.
Imai A, Iida K, Tamaya T. Direct action of gonadotropin-releasing hormone (LH-RH) analogue on ovary: An alternative acting mechanism of buserelin. Arch Gynecol Obstet 1991;248:117-21.  Back to cited text no. 8
    
9.
Stephens JW, Katz JR, McDermott N, MacLean AB, Bouloux PM. An unusual steroid-producing ovarian tumour: Case report. Hum Reprod 2002;17:1468-71.  Back to cited text no. 9
    


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