Virilization and Pelvic Pain in a Premenopausal Ovarian Steroid Cell Neoplasm

Abstract

Background: Ovarian neoplasms generally considered as derived from surface epithelium, stromal tissue, or germ cells within the ovary. Steroid cell tumors are classified as stromal tumors, and these neoplasms comprise less than 0.1% of all ovarian neoplasms. Steroid cell tumors could be classified as Leydig cell, stromal-luteal or not otherwise specified. NOS neoplasms are the most common type of steroid cell neoplasm. This report describes an ovarian steroid cell tumor attaching to a eutopic left ovary and its clinical course in a 33-year old woman with an extensive medical history. Case Information: We present a woman who initially complains of pelvic pain and virilization, with a history of PCOS. Secondary to uncontrolled blood glucose and concern for surgical risk, her symptoms progressed over a 2-year course. After being lost to follow-up for a time, this patient underwent a right sided salpingectomy and left salpingo-oophorectomy. Pathology reported this to be a steroid cell tumor, not otherwise specified of which there are fewer than 25 cases out in current literature. To date, this patient recovered well and has not has a resurgence of this neoplasm. Conclusions: Her uncontrolled diabetes and HIV status remained barriers to devise and adhere to treatment plans. Presumptive PCOS overlying or potentiating neoplastic symptoms may have led to delayed diagnosis. In addition, the persistence of some hirsutism may support PCOS as a culprit for her facial hair, as her postoperative serum Testosterone levels were normal. This is the first patient presentation of this specific tumor who was HIV positive and especially given the lack of diagnostic or treatment algorithm it will be valuable to follow this patient after the mass removal, even though her symptoms did completely resolve.