A stromal leydig cell tumor of the ovary occurring in a pregnant 15-year-old girl. Ultrastructural findings

Abstract

The first case of stromal Leydig cell tumor of the ovary occurring during pregnancy is reported. A 15-year-old girl presented in labor at 36.5 weeks of gestation. The tumor mass was obstructing labor and the patient had to be delivered by cesarean section. Unique features of this case included the young age of the patient, the large size of the tumor, and the associated pregnancy. The tumor was encapsulated and showed the typical histologic and ultrastructural features of ovarian stromal Leydig cell tumor. The literature is reviewed, and the differential diagnosis is discussed.Cancer 60:2806-2810, 1987. HE OVARIAN STROMAL LEYDIG CELL TUMOR iS aT rare neoplasm, with only six cases reported in the literature.'.* The usual presentation is in the postmenopausal female who is often virilized, due to the clinically significant amounts of androgens produced by this neoplasm. We report a case of a stromal Leydig cell tumor of the ovary encountered near term in a pregnant 15 year old girl. Case ReportThe patient, a 15-year-old gravida 1 para 0 black female, presented in labor at 36.5 weeks gestation. She complained of facial edema and temporal headaches, and was considered to show signs of mild preeclampsia. Clinical examination revealed a large, firm nontender mass in the cul-de-sac. Ultrasound showed a homogeneous echogenic mass approximately 10 cm in greatest dimension. This mass was felt to be ostructing labor, and displacing the uterine cervix anteriorly and superiorly. A cesarean section was performed, and a 2300-g female infant was delivered without difficulty. A large, firm, encapsulated tumor was present in the right ovary. The tumor did not appear to involve the ovarian hilus, and was blunt-dissected from the ovarian tissue. The patient was not obviously virilized, but on further questioning had noted an increase in facial and body hair, and deepening of the voice during the second half of the pregnancy. Hormonal tests were not performed preoperatively. There was no evidence of virilization of the female infant. The patient showed partial regression of the virilization and was well 2.5 years after diagnosis. The child was developing normally. ResultsThe ovarian tumor consisted of an oval mass which measured 12.0 X 10.0 X 4.0 cm, and weighed 320 g. A thick, smooth, glistening tan-white capsule was present. On sectioning, the tumor was homogeneous, solid, soft, edematous, and composed of yellow-tan tissue. Histologically, the tumor was surrounded by a thin rim of ovarian tissue composed of stromal cells containing primordial follicles, which suggested that the tumor was cortical or subcortical in origin. The tumor, which showed marked edema, consisted of nests of plump, polygonal Leydig cells with abundant, eosinophilic, slightly granular cytoplasm (Fig. 1 ), and round-to-oval uniform nuclei with prominent nucleoli (Fig. 2). The nests of Leydig cells were admixed with a population of ovoid and spindle shaped cells with pale cytoplasm and with a thecoma-like appearance. Crystalloids of Reinke were focally identifi...

An ovarian stromal tumor with luteinized cells: an unusual recurrence of an unusual tumor

“…Very few cases of stromal Leydig cell tumors have been reported in the literature. In addition to Zhang’s series, two have been reported in young women (7,8) .…”

Rare recurrence of a rare ovarian stromal tumor with luteinized cells: a case report

“…Very few cases of stromal Leydig cell tumors have been reported. In addition to the series of Zhang and colleagues [6], two have been reported in young women [7,8]. Surgical intervention is generally adopted as the primary mode of treatment; this is often conservative in young women wishing to retain their fertility.…”

Leydig-Cell-Tumor of the Ovary that Responded to GnRH-Analogue Administration – Case Report and Review of the Literature

“…To date, approximately 110 cases of Leydig cell tumors have been described. These tumors usually occur in postmenopausal women ( Young and Scully, 2002 ), at an average age of 58, but cases in younger women ( Takeuchi et al, 1999, Marcondes et al, 1997, Horny et al, 1995, Oler et al, 1999, Bohlmann et al, 2005, Nishiyama et al, 2008, Drife et al, 1987 ( Paoletti et al, 1987, Zhang et al, 1982. In men, 7 -10 % of LCTs are malignant, these tumors are highly resistant to both radiation and chemotherapy, have a great recurrence rate after surgery, and most patients die within 2 years of the discovery of metastatic disease ( Bertram et al, 1991 ).…”