ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2009) 20 P306

Stromal luteoma of the ovary: case report

Selma B Souto1, Daniel Carvalho-Braga1, Pedro Vieira Baptista2, Ana S Fernandes2, Jorge Beires2 & José Luís Medina1

1Endocrinology Department, São João Hospital, Porto, Portugal; 2Obstetrics and Gynecology Department, São João Hospital, Porto, Portugal.

Introduction: The stromal luteoma of the ovary is a rare tumour occurring mostly in post menopausal women. Endocrine symptoms and sometimes virilizing signs may be observed, although abnormal vaginal bleeding is the most frequent manifestation. This tumour is surrounded by ovarian stroma being entirely composed of luteinized cells devoid of crystals of Reinke. Hyperthecosis of ovarian stroma is often observed. Its evolution is always benign.

Case report: Women, 64 years old, revealing history of hypertension, obesity, primary infertility and obstructive sleep apnoea. The patient was sent to the outpatient clinic for hirsutism, alopecia androgenetic for the last three years and reduced libido. Her physical examination revealed hirsutism (score >6, Ferriman-Gallwey scale) and frank virilization. She had a normal gynecological examination. Her serum testosterone and 17-hidroxiprogesterone levels were increased with normal serum androstenedione and DHEA levels. The abdominal–pelvis axial computerized tomography and the pelvis magnetic resonance imaging showed a solid nodule, with 16–19 mm of diameter in the left ovary, confirmed by endovaginal ultrassound. The patient underwent a bilateral oophorectomy and the histology revealed a stromal luteoma of the ovary. After surgery, the patient revealed clinical improvement and rapid normalized the androgen levels.

Discussion: The diagnosis of virilizing tumours of the ovary is often difficult and challenge, especially in small tumours, not detectable in gynaecological examination. In a women with virilization signs is essential a careful gynaecological examination, the measure of serum androgens and the axial computorized tomography of adrenal and ovary to exclude an androgen production tumour. Nevertheless, the transvaginal ultrasound is the most sensitive method for the detection of an ovarian tumour.

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