Journal of pediatric and adolescent gynecology · 2024
Virilization, Ovarian Hyperthecosis, and Torsion Masquerading as Malignancy: A Case Report.
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Morrison Aimee, Wassmer Taryn, Swauger Sarah, Berklite Lara, Pennesi Christine
Аннотация
BACKGROUND: Premenopausal females with signs of androgen excess and oligomenorrhea are commonly evaluated for polycystic ovarian syndrome or for an androgen-secreting tumor if a pelvic mass is present. Ovarian hyperthecosis (OHT) as a cause of these symptoms in adolescents is rare.
CASE: A 15 year-old female with primary amenorrhea and signs of virilization was referred to Pediatric and Adolescent Gynecology after pelvic imaging demonstrated a pelvic mass, suspected to be arising from the right ovary, and an adjacent paratubal cyst. Preoperative laboratory evaluation revealed markedly elevated testosterone levels (free testosterone 81.5 pg/mL [normal <7.5 pg/mL]; total testosterone 279.6 ng/mL [normal <52.0 ng/mL]). Ovarian tumor markers were otherwise normal. Surgical evaluation revealed bilaterally enlarged ovaries and right paratubal cyst with right ovarian torsion. Rather than demonstrating an androgen-secreting tumor, pathologic evaluation following right salpingo-oophorectomy resulted in an unexpected diagnosis of OHT.
SUMMARY AND CONCLUSION: Our case demonstrates that OHT should be considered in the differential in the setting of a large pelvic mass and virilization in an adolescent.
CASE: A 15 year-old female with primary amenorrhea and signs of virilization was referred to Pediatric and Adolescent Gynecology after pelvic imaging demonstrated a pelvic mass, suspected to be arising from the right ovary, and an adjacent paratubal cyst. Preoperative laboratory evaluation revealed markedly elevated testosterone levels (free testosterone 81.5 pg/mL [normal <7.5 pg/mL]; total testosterone 279.6 ng/mL [normal <52.0 ng/mL]). Ovarian tumor markers were otherwise normal. Surgical evaluation revealed bilaterally enlarged ovaries and right paratubal cyst with right ovarian torsion. Rather than demonstrating an androgen-secreting tumor, pathologic evaluation following right salpingo-oophorectomy resulted in an unexpected diagnosis of OHT.
SUMMARY AND CONCLUSION: Our case demonstrates that OHT should be considered in the differential in the setting of a large pelvic mass and virilization in an adolescent.