Ovarian granulosa cell tumor: An uncommon presentation with primary amenorrhea and virilization in a pubertal girl

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Abstract

A 16-year-old girl presented with primary amenorrhea and excess hair growth on her body and face for the last three years, along with pain and a mass in her lower abdomen for last one year. Examination revealed hirsutism and other virilizing features, with an irregular mass in the lower abdomen corresponding to 16 weeks’gestation. Serum testosterone was 320 ng / dl and ultrasonogram of the pelvis revealed a solid mass of 5 × 4 cm in the left adnexa. Suspecting it to be a virilizing tumor of the left ovary, the patient was subjected to staging laparotomy, which revealed stage 1a ovarian involvement amenable to surgical resection alone. Histopathological examination confirmed the diagnosis of granulosa cell tumor of the ovary. Postoperatively the serum testosterone returned to 40 ng / dl and her menstrual cycle started after two months of surgery.

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A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia.

Christopher Kane, Nicole Anderson, H Mamtora … (1994)

To determine the frequency of polycystic ovaries (PCO) on ultrasound and the incidence of clearcut endocrine disorders leading to virilization in patients complaining of hirsutism or androgenic alopecia. The major purpose was to determine a coherent policy for the routine biochemical assessment of such women. A prospective study of women attending a joint skin/endocrine clinic complaining of these problems. Three hundred and fifty consecutive women with hirsutism and/or androgenic alopecia were assessed. Baseline endocrine screens were conducted on two occasions and included measurement of serum testosterone, androstenedione, dehydroepiandrosterone sulphate, sex hormone binding globulin, LH, FSH, 17-hydroxyprogesterone and PRL. The ovaries were visualized by high-resolution pelvic ultrasound scanning. Eight women were identified with relevant endocrine disorders; of these, one was acromegalic and one had a microprolactinoma--in both cases the association may have been fortuitous. Three had clear-cut 21-hydroxylase deficiency, one a rare hepatic enzyme deficiency (11-reductase), one a virilizing adrenal carcinoma and one a Leydig cell tumour. The latter six cases all had persistently elevated levels of serum testosterone (> 5 nmol/l). In all, 13 women had baseline testosterone levels in excess of 5 nmol/l. Polycystic ovaries were present in 81% of the cases who had erratic cycles and 52% of those with regular cycles; PCO were present in two of the women with 21-hydroxylase deficiency and in the woman with 11-oxoreductase deficiency. The Leydig cell tumour (1.2 cm diameter) was not detected on ultrasound or CT scan. For the exclusion of enzyme deficiencies and virilizing tumours clinical assessment and a single serum testosterone measurement will suffice.

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Ovarian thecoma with ascites and high serum levels of CA125.

K Hasegawa, M Takemori, R Nishimura (2000)

We report a 34-year-old woman with an ovarian thecoma and ascites who exhibited high serum levels of CA125. Measuring serum tumor markers and imaging are two important diagnostic tools for malignant ovarian tumors. In the present case, a preoperative diagnosis of benign ovarian tumor could not be made due to the elevation of CA125 (895 U/ml) and nonspecific MRI findings.

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Ovarian thecoma with androgenic manifestations in a postmenopausal woman.

Krzysztof Sworczak, S. Wojtylak, Anna Babinska … (2006)

A 50-year-old woman, who presented with progressive androgenization, central obesity and severe hypertension, was initially suspected to have an adrenal virilizing tumor. Her serum testosterone level was in the male range (9.3-11.6 ng/ml) and was not suppressed with dexamethasone. Although no pathological abdominal or pelvic mass was detected, total hysterectomy and bilateral salpingo-oophorectomy was performed. Histopathological examination revealed a theca-cell tumor of the right ovary. Postoperatively the testosterone level returned to normal and the patient had regression of virilism. Our case illustrates that a virilizing ovarian tumor can be small and elude imaging studies, but may be detected by means of well-considered clinical management.

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Author and article information

Journal

Journal ID (nlm-ta): Indian J Endocrinol Metab

Journal ID (iso-abbrev): Indian J Endocrinol Metab

Journal ID (publisher-id): IJEM

Title: Indian Journal of Endocrinology and Metabolism

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 2230-8210

ISSN (Electronic): 2230-9500

Publication date (Print): Sep-Oct 2012

Volume: 16

Issue: 5

Pages: 836-839

Affiliations

[1] Department of Endocrinology, Medwin Hospital, Hyderabad, Andhra Pradesh, India

[1 ] Department of Obstetrics and Gynecology, Riyadh Care Hospital, Riyadh, Saudi Arabia

[2 ] Department of Obstetrics and Gynecology, Apollo Hospital, Bhubaneswar, Orissa, India

[3 ] Department of Medicine, MKCG Medical College, Berhampur, Orissa, India

[4 ] Department of Anesthesia, Central Security Hospital, Riyadh, Saudi Arabia

Author notes

Corresponding Author: Dr. Sunil Kumar Kota, Department of Endocrinology, Medwin Hospital, Chiragh Ali Lane, Nampally, Hyderabad – 500 001, Andhra Pradesh, India. E-mail: hidocsunil@ 123456ibibo.com

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Publisher ID: IJEM-16-836

DOI: 10.4103/2230-8210.100658

PMC ID: 3475918

PubMed ID: 23087878

SO-VID: 793437e3-b3c2-4094-a9d5-f83ce50aa8db

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Ovarian granulosa cell tumor: An uncommon presentation with primary amenorrhea and virilization in a pubertal girl

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Journal of the ASEAN Federation of Endocrine Societies

Most cited references 10

A prospective study of the prevalence of clear-cut endocrine disorders and polycystic ovaries in 350 patients presenting with hirsutism or androgenic alopecia.

Ovarian thecoma with ascites and high serum levels of CA125.

Ovarian thecoma with androgenic manifestations in a postmenopausal woman.

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