Steroid Cell Tumour of Ovary – A Rare Case Report

Abstract

A 55-year-old postmenopausal lady presented with complaints of bleeding per vaginum and lower abdominal pain for the last 3-4 months. She also had increased body hair for last 3-4 years. She had three children and there was no history of any abnormality during her pregnancy. There was no history of any contraception and exogenous hormone intake.Past medical history was otherwise unremarkable. Family history was noncontributory. Ultrasonography revealed a hypoechoic right adenexal mass measuring 65x40x30mm. This mass was not separated from right ovary. A possibility of ovarian sex cord tumour was given. A total hysterectomy with bilateral salpingooophorectomy was done and the specimen was received in our department for histopathological examination.An already cut open gross specimen of uterus was received measuring 9x6x3.5cm in size with one tube and ovary and other fallopian tube and ovary lying separately in container. Ovarian tumour measured 6x4x3cm. It was replacing whole of the ovary without any peripheral ovarian stroma. Cut surface was solid and yellow in colour [Table/ Fig-1a&b]. Other side ovary was grossly normal. Specimen of omentum measuring 45cm in length was also received.Sections from ovarian tumour showed well circumscribed tumour comprising of large round to polygonal cells with centrally placed nuclei, prominent nucleoli and abundant amount of eosinophilic cytoplasm [Table/ Fig-2a&b]. There was no atypia, mitotic figures or necrosis noted in the tumour. Stroma was scanty. Histological features were consistent with steroid cell tumour NOS type. The cervix showed features of chronic cervicitis while the endometrium showed atrophic changes. The other side ovary and tube was unremarkable. Patient was discharged after 1 week with stable condition and was adviced follow up after 1 month. Patient's excessive hair growth reduced after few months and there were no other complaints. DisCussionThe incidence of steroid cell tumours, NOS is highest in women of child bearing age group, particularly during the third and fourth decades, but in rare cases postmenopausal women or children may also have this tumour. Androgenic manifestations are common in these tumours as they secrete hormones like androstenedione, α-hydroxyprogesterone, and testosterone [1,2].These tumours are known to produce symptoms of virilisation particularly hirsutism. So in cases where there is unexplained hirsutism, ovarian and adrenal tumour association should be ruled out as there may be occult malignancies [3]. However, there may be atypical presentations of these tumours also when they do not show any symptoms of virilisation. In these cases the diagnosis is usually made postoperatively on finding a tumour in ovary [4].These tumours have been divided into three subtypes according to their cells of origin: stromal luteoma, leydig cell tumour and steroid cell tumour, not otherwise specified (NOS). Of these subtypes, the steroid cell tumours, NOS account for about 56% of steroid cell tumours [5].A majority of steroid cell tumour NOS are ...

Malignant Ovarian Steroid Cell Tumor Causing Severe Hyperandrogenism: Case Report And Review Of The Literature

“…Combined clinical and pathologic findings provide the optimal approach to distinguish patients who have malignant SCT from those who have benign tumors or indolent disease that can be managed by surgical intervention only. This is demonstrated by a recent report by Bhagat et al (19) of a 55-year-old patient with virilization and a 6-cm SCT NOS (19). The patient had three previous successful pregnancies, indicating that her disease was of relatively recent onset.…”

Steroid cell tumour of ovary: A rare clinicopathologic entity

“…rarely it can occur in post-menopausal women and in young children. 2 Steroid cell tumors are sex cord stromal tumours and are sub-classified into 3 typesstromal luteoma, Leydig cell tumour and not otherwise specified. SCT-NOS signifies that the cell lineage is not defined and thus, cannot be categorized as either stromal luteomas or Leydig cell tumors.…”

“…SCT-NOS signifies that the cell lineage is not defined and thus, cannot be categorized as either stromal luteomas or Leydig cell tumors. 2,3 These tumors represent a unique cause of female virilization. Approximately 56-77% of the cases are clinically associated with androgenic changes, such as hirsutism and virilization; 6-7% of the cases are clinically associated with cushing's syndrome; and 25% of SCT-NOS are non-functional.…”

“…2 In cases of unexplained hirsutism, ovarian and adrenal tumour association should be ruled out and occult malignancies must be investigated for. We here by present a case report of 48 years old postmenopausal lady with signs of androgen excess and postmenopausal bleeding, which is finally proved to be a Steroid cell tumor-Not otherwise specified (SCT-NOS).…”

Steroid Cell Tumor of Ovary Diagnosed After Delivery; Case Report

“…Macroscopically, the tumor is seen as a solid, well circumference tumoral mass with occasional hemorrhage and cystic formations. [16][17][18][19] In a cytological examination, polyglonal or round cells with distinctive borders and central and prominent nucleoli are seen. 20 SCTs are differentiated from Leydig cell tumors by the absence of Reinke's crystals.…”