Virilizing hilus (Leydig) cell tumor of the ovary: the challenge of an accurate preoperative diagnosis

A 73-year-old woman developed temporal balding and "hoarseness" over a 3-year interval. Investigation including extensive endocrinologic screening, abdominal computed tomography scanning, pelvic ultrasonography, iodocholesterol (NP-59) adrenal scanning, and selective retrograde venous samp...

Full description

Saved in:
Bibliographic Details
Published inSurgery Vol. 94; no. 6; p. 951
Main Authors Raaf, J H, Bajorunas, D R, Smith, D H, Woodruff, J
Format Journal Article
LanguageEnglish
Published United States 01.12.1983
Subjects
Aged
Female
Humans
Leydig Cell Tumor - complications
Leydig Cell Tumor - diagnosis
Leydig Cell Tumor - surgery
Middle Aged
Ovarian Neoplasms - complications
Ovarian Neoplasms - diagnosis
Ovarian Neoplasms - surgery
Virilism - diagnosis
Virilism - etiology
Online AccessGet more information

Cover

More Information
Summary:A 73-year-old woman developed temporal balding and "hoarseness" over a 3-year interval. Investigation including extensive endocrinologic screening, abdominal computed tomography scanning, pelvic ultrasonography, iodocholesterol (NP-59) adrenal scanning, and selective retrograde venous sampling revealed only an elevated serum testosterone level without localization of the source. At laparotomy a 2.0 cm left ovary was found to contain a hilus (Leydig) cell tumor. The testosterone level in a blood sample from the left ovarian vein obtained intraoperatively was 9000 ng/dl, whereas a blood sample from the right ovarian vein contained 213 ng/dl. One week later her peripheral blood testosterone level was normal (8 ng/dl). The records of six other patients with ovarian hilus cell tumors were reviewed from the Memorial Hospital Registry (from 1959 to 1982). All tumors were small (ovaries were 2 to 4 cm in diameter) and benign. The average patient's age was 63 years (range: 57 to 73 years). Only three of the seven patients in our series were first seen with virilization; the tumors in the remaining four patients were found incidentally. Ovarian hilus cell tumors are rare and are difficult to diagnose, but surgeons and endocrinologists should think of this tumor when they investigate older female patients with virilization. Careful intraoperative examination of even normal-appearing ovaries is imperative, particularly if no adrenal disease is found.
ISSN:0039-6060