Zhu XD, Zhou LY, Jiang J, Jiang TA. Postmenopausal women with hyperandrogenemia: Three case reports. World J Clin Cases 2021; 9(28): 8482-8491 [PMID: 34754857 DOI: 10.12998/wjcc.v9.i28.8482]
Corresponding Author of This Article
Tian-An Jiang, MD, Chief Physician, Director, Department of Ultrasound Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310006, Zhejiang Province, China. tiananjiang@zju.edu.cn
Research Domain of This Article
Radiology, Nuclear Medicine & Medical Imaging
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Xiao-Dan Zhu, Lin-Yu Zhou, Jian Jiang, Tian-An Jiang, Department of Ultrasound Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310006, Zhejiang Province, China
Author contributions: Zhu XD drafted the manuscript, collected the data, and reviewed the literature; Zhou LY and Jiang J performed the histological examination and reviewed the manuscript; Jiang TA provided academic help, and critically reviewed the manuscript; All authors have confirmed and approved the final manuscript.
Supported byNational Natural Science Foundation of China, No. 81971623, and No. 82027803.
Informed consent statement: Informed written consent was obtained from patients for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist(2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Tian-An Jiang, MD, Chief Physician, Director, Department of Ultrasound Medicine, The First Affiliated Hospital of Zhejiang University School of Medicine, No. 79 Qingchun Road, Hangzhou 310006, Zhejiang Province, China. tiananjiang@zju.edu.cn
Received: March 12, 2021 Peer-review started: March 12, 2021 First decision: June 24, 2021 Revised: July 5, 2021 Accepted: August 18, 2021 Article in press: August 18, 2021 Published online: October 6, 2021 Processing time: 199 Days and 21.1 Hours
Abstract
BACKGROUND
Diagnosing hyperandrogenemia in postmenopausal women is very difficult. It occasionally manifests as excessive hair growth or with no clinical manifestations, and is therefore often misdiagnosed or missed altogether. Ovarian steroid cell tumors that cause hyperandrogenemia in women account for approximately 0.1% of all ovarian tumors. Due to the low incidence, corresponding imaging reports are rare, so ovarian steroid cell tumors lacks typical imaging findings to differentiate it from other ovarian tumors. Therefore, we summarized its clinical and imaging characteristics through this case series, and elaborated on the differential diagnosis of steroid cell tumors.
CASE SUMMARY
We report three cases of postmenopausal women with hyperandrogenemia. Only 1 patient showed virilization symptoms, the other two patients were completely asymptomatic. All patients underwent total hysterectomy + bilateral adnexectomy. Histological results showed one case of Leydig cell tumor and two cases of benign, non-specific steroid cell tumor. After the operation, the androgen levels of all patients returned to normal, and there was no clinical recurrence since follow-up.
CONCLUSION
Although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors, it is often asymptomatic. A solid, slightly hypoechoic, round or oval mass with uniform internal echo, richer blood flow in the solid part, and low resistance index are typical imaging features of ovarian steroid cell tumors. Diagnosis of ovarian steroid cell tumors after menopause is challenging, but surgery can be used for both diagnosis and clear treatment.
Core Tip: Ovarian steroid cell tumors are a rare sex cord-stromal tumor accounting for approximately 0.1% of all ovarian tumors. Although virilization caused by increased serum testosterone levels is an important clinical feature of ovarian steroid cell tumors, it is often completely asymptomatic. Therefore, while paying attention to the typical imaging features of ovarian steroid cell tumors, we cannot ignore clinically asymptomatic patients, especially postmenopausal women.
