Ovarian Steroid Cell Tumor: Report Of Four Cases

SUMMARY Steroid cell tumors are tumors that account for less than 0.1% of all ovarian malignant tumors and cause increase in secretion of androgen or estrogen. Steroid cell tumors usually occur in the post-menopausal period. This article reports four steroid cell tumor cases who underwent surgery for overian mass during post-menopausal period, who were diagnosed with steroid cell tumor after histopathological examination and displayed different clinical manifestations. No signs of increased hormonal activity in two of these cases were observed. On the other hand, the other two cases applied with complaints of menopausal vaginal bleeding, which led to the consideration of increased estrogenic activity in these two cases. Case 1 The case, who was 77 years of age in her postmenopausal period, applied to our hospital with the complaint of urinary incontinence. The routine laboratory findings of the patient, who had no feature in her history, were within normal limits. No findings of virilization were observed during the physical examination of the patient. During the gynaecological examination, a mass of approximately 6 cm was detected in the right adnexal area. The transvaginal ultrasonography (TVUSG) revealed an endometrial thickness of 9 mm, and an approximately 72mm-sized solid-cystic mass, surrounded with free liquid in the right ovary area. The preoperative Case 2 In the TVUSG performed during the routine follow- up examinations at the menopause clinic of the 52 year-old case, who did not have active complaints, a 66 X 35 mm mass with the possibility of dermoid cyst was detected in the right ovary. There was no feature in the patient's physical examination, her history and family history. The gynaecological examination, during which an approximately 6 cm mass was palpated in the right adnexial area, revealed a CA 125 value of 9.07 IU/ml. With the preliminary diagnosis of pelvic mass, laparoscopic right salpingo-ooforectomy was performed. The intraoperative pathological examination reported "malignancy was not observed". The paraffin block indicated a right ovarian steroid cell tumor; the largest diameter of the capsule was 8 cm and the capsule had a ruptured appearance; there was 1 mitosis /10 HPF, focal light atypia and focal hemorrhage but there was no presence of necrosis. Based on these findings, it was decided that the potential for malignancy was low. Adjuvant treatment during the postoperative period was not considered. The patient did not come to the follow-up examinations after the operation. Figure 2: The postoperative paraffin block section of case 1. Case 3 The 64-year-old case who was in her postmenopausal period applied to our hospital with vaginal bleeding complaints. The routine laboratory findings of the patient, who had no feature in her history and family history, were within normal limits. In the physical examination of the case, virilization and increased hormonal activity findings were not observed. It was thought that postmenopausal vaginal bleeding could be associated with hyperestrogenic environment. A 10 cm-diameter mobile mass, the borders of which could not be clearly differentiated from the uterus and right ovary and filled up the Douglas space, was detected during the gynaecological examination. The TVUSG