Discriminating between virilizing ovary tumors and ovary hyperthecosis in postmenopausal women: clinical data, hormonal profiles and image studies.

BACKGROUND: The presence of virilizing signs associated with high serum androgen levels in postmenopausal women is rare. Virilizing ovarian tumors (VOTs) and ovarian stromal hyperthecosis (OH) are the most common etiologies in virilized postmenopausal women. The differential diagnosis between these two conditions is often difficult. OBJECTIVE: To evaluate the contribution of clinical features, hormonal profiles and radiological studies to the differential diagnosis of VOT and OH. DESIGN: A retrospective study. SETTING: A tertiary center. MAIN OUTCOME MEASURES: Clinical data, hormonal status (T, E2, LH and FSH), pelvic images (transvaginal sonography and MRI) and anatomopathology were reviewed. PATIENTS: Thirty-four postmenopausal women with a diagnosis of VOT (13 women) and OH (21 women) were evaluated retrospectively. RESULTS: Clinical signs of hyperandrogenism were more prevalent in the VOT group than the OH group. Although the VOT group showed higher T and E2 levels and lower gonadotropin levels than the OH group, a great overlap occurred among the hormone levels. A pelvic MRI provided an accurate differentiation of these two conditions. CONCLUSION: In this group of patients, the main features contributing to the differential diagnosis of VOT and OH were serum levels of testosterone and gonadotropins and the presence of an ovarian nodule identified on the MRI. Although the association of clinical, hormonal and radiological features contributes to the differential diagnosis of these two conditions, histopathological analysis remains the gold standard for the diagnosis of ovarian hyperandrogenism in postmenopausal women.

Vestibulodynia: A Multifactorial Syndrome: A Case Report.

BACKGROUND: Vulvodynia is a difficult-to-treat, chronic, multifactorial malady that drastically lowers the quality of life of afflicted patients. CASE: A 68-year-old woman, who had been treated successfully for vulvodynia years before with medication, returned with a recurrence of vulvodynia symptoms that this time did not respond to treatment. She now had biopsy-confirmed lichen sclerosis and was found to have markedly elevated serum testosterone levels. An imaging study detected an ovarian lesion that, on removal, proved to be afibrothecoma. Postoperatively the testosterone rapidly dropped to normal levels. What was unexpected and unusual was that the vulvar pain disappeared and the lichen sclerosis markedly regressed. CONCLUSION: This case demonstrates a hormonal trigger for the development of vulvodynia.

Meigs' syndrome with elevated serum CA 125 level in a case of ovarian fibrothecoma.

Meigs' syndrome is the association of benign ovarian tumor, pleural effusion, and ascites. Meigs' syndrome with marked elevated CA 125 is a rare clinical entity and only 42 cases have been reported. Although there is difficulty in discerning the diagnosis of Meigs' syndrome from that of an ovarian malignancy, it should be considered in the differential diagnosis in postmenopausal patients with an ovarian mass, hydrothorax, ascites, and elevated CA 125. In this report, the authors present the case of a 52-year-old postmenopausal woman with ovarian fibrothecoma, pleural effusion, ascites, and elevated CA 125 (319.2 IU/ml). Exploratory laparotomy with total hysterectomy and bilateral salpingo-oophorectomy was performed, and the pathologic diagnosis was ovarian fibrothecoma. After the surgery, the pleural effusion disappeared spontaneously and the CA 125 became normal. The authors also summarized other cases of Meigs' syndrome with elevated CA 125, and reviewed the mechanism of elevation of CA 125, ascites, and pleural effusion.

Ovarian thecoma with virilizing manifestations.

A 29-year-old woman presented with secondary amenorrhea, primary infertility, and virilization, which had developed over the past 2 years was suspected to have a virilizing tumor at her left ovary. Her serum testosterone level was markedly elevated (380 ng/dL). Left salpingoophorectomy was performed, and histopathological examination revealed a thecoma of the left ovary. The postoperative serum testosterone level returned to 65 ng/dL. The patient did not have regression of virilism soon. However, the patient had a normal menstruation 29 days after surgery and gave birth to a baby 13 months after surgery.

[Comparision of sonographic findings and pathological features in ovarian thecoma].

OBJECTIVE: To compare the sonographic findings with pathological features of ovarian thecoma, and to analyze the relationship between them. METHODS: The sonograms of 45 ovarian thecoma cases were reviewed retrospectively and categorized into three subtypes as sound attenuation pattern, homogeneous hypoechoic pattern and solid and cystic mixed pattern. The pathological findings were classified as theca cell-predominant, fibroblast-predominant and mixed thecoma according to the cellular composition of the tumors. Hyaline degeneration and luteinization of the tumors were recorded. The pathologic findings of each subtype based on sonography were compared. RESULTS: Of the 45 patients, there were 34 (75.6%) solid ovarian lesions, 15 (33.3%) of those showed a sound-attenuation pattern with an anterior hypoechoic zone and posterior acoustic attenuation in sonography, the other 19 (42.2%) cases had homogeneous hypoechoic pattern with no posterior acoustic attenuation, and the remaining 11 (24.4%) cases presented as a solid and cystic mixed pattern. There were no significant differences in pathological cellular composition among the three sonographic subtypes. Five solid tumors containing hyaline degeneration and one with luteinization were found to have posterior acoustic attenuation. The solid and cystic mixed thecomas showed cystic degeneration and hemorrhage. CONCLUSION: Solid ovarian thecomas usually have typical sonographic features, which may be associated with degeneration but not with cellular composition within the tumor.

Bilateral occurrence of granulosa-theca cell tumors in an Arabian mare.

An Arabian mare was referred for right granulosa-theca cell tumor (GTCT) evaluation. The mare was presented 4.5 years later for a left GTCT, after successfully conceiving and delivering a normal foal in the interim. The concurrent or nonconcurrent occurrence of bilateral GTCT in mares appears to be rare.

Meigs' syndrome with elevated CA 125: case report.

CONTEXT: Meigs' syndrome consists of a benign ovarian tumor accompanied by ascites and hydrothorax. Elevated serum CA 125 levels in postmenopausal women with solid adnexal masses, ascites and pleural effusion are highly suggestive for malignant ovarian tumor. However, patients with Meigs' syndrome can also have elevated serum CA 125 levels. The authors report a case of Meigs' syndrome with elevated CA 125 level. OBJECTIVE: This is a case report of Meigs' syndrome with elevated CA 125 level. CASE REPORT: A 65-year-old Brazilian woman had presented progressive dyspnea, weight loss and decline in general condition over the 7 months preceding admission to our service. In another hospital, the patient had been submitted to thoracic drainage due to pleural effusion. With recurrence of the pleural effusion and increase in abdominal volume due to ascites and a pelvic mass, the patient sought our service. Transvaginal ultrasound showed an extensive adnexal solid mass of 16.4 x 10.8 cm located in the pelvis without exact limits, and the serum CA 125 level was elevated. With a preoperative diagnosis of ovarian carcinoma, the patient was submitted to exploratory laparotomy, which revealed a left ovarian tumor. The frozen section diagnosis was thecoma. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed. The histology of the specimen confirmed the diagnosis of thecoma. The patient was asymptomatic with a normal serum CA 125 level 20 months after the operation.

Endocrinological changes before and after removal of the granulosa theca cell tumor (GTCT) affected ovary in 6 mares.

To clarify the endocrinological characteristics of the mares with granulosa theca cell tumor (GTCT), peripheral plasma samples from the 6 mares affected with GTCT were collected before and after the surgical removal of the affected ovary. Concentrations of testosterone (T), follicle stimulating hormone (FSH), luteinizing hormone (LH), immunoreactive-inhibin (ir-INH), progesterone (P) and estradiol-17beta (E(2)) in the plasma samples were measured by radioimmunoassay. Before removal of GTCT in all cases, the concentrations of T were significantly higher than those of normal mares at the breeding and non-breeding seasons, whereas plasma concentrations of FSH, LH, ir-INH, P and E(2) were lower. After surgical removal of the affected ovary, the circulatory concentrations of T was declined, but the concentrations of other hormones were constantly low as compared with those of normal mares. The present study suggests that 1) the source of higher T may be due to the abnormal follicles in ovary of GTCT, 2) in the case of GTCT the elevated level of T is observed due to the lack of aromatase, and 3) the high level of T is a typical characteristics for GTCT in mares. It is also suggested 4) due to the elevated levels of T the concentrations of gonadotropins may be suppressed.

[Virilism during pregnancy]. / Virilisme au cours de la grossesse: à propos d'un cas.

We discuss the causes of virilism in pregnancy and the impact of hyperandrogeny on the female foetus. We report a case of virilism in a 28-year-old, gravida 1, para 1 patient with normal pregnancy and review the literature. After conception, the patient had been well until the 18th week of gestation, when she developed signs of virilization; her serum testosterone was markedly elevated. She delivered of a normal male infant at term. After delivery, signs of virilization regressed with normalization of testosterone level but a wide mass of the left ovary that persisted for 8 months. The histological study of the tumor showed luteinized thecoma. Luteomas and hyper-reactio luteinalis were the principal causes of virilism in pregnancy, thecomas are rare.

[Case report of a granulosa-theca tumor in a cow]. / Case study van een granulosa-thecaceltumor bij het rund.

A 2 year-old cow with abnormal behaviour was observed during a farm visit. Rectal palpation of the cow revealed the presence of a mass of at least 12 cm in diameter. After further examination, it appeared that 'ovarian tumour' was the most likely differential diagnosis. In order to confirm this diagnosis, blood samples were drawn and analysed for plasma progesterone and plasma oestradiol-17 beta concentrations. Also, the gross pathology and histology of the mass were evaluated. The combination of the clinical presentation of the cow, the hormone concentrations, and the histological appearance of the mass confirmed the diagnosis ovarian tumour. The tumour was classified as granulosa-theca cell tumour.

Ovarian thecoma with ascites and high serum levels of CA125.

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.

Accuracy of tissue polypeptide specific antigen (TPS) in the diagnosis of ovarian malignancy.

This paper evaluates the usefulness of determining the level of serum Tissue Polypeptide Specific Antigen (TPS) by TPS ELISA in the diagnosis of ovarian malignancies and compares it with the results of histological examination of the ovaries. The study covers 92 patients who had been clinically diagnosed with ovarian tumors by history, physical examination and pelvic examination with or without pelvic ultrasonography. All of them underwent surgical treatment by exploratory laparotomy in Siriraj Hospital between May 1, 1996 and 31 March, 1997. None of the patients had been treated with chemotherapy or hormonal therapy, and in no case were there any previously diagnosed malignancies. TPS was measured in the serum of 92 patients who were preoperatively diagnosed with ovarian tumor: 52 patients had benign pelvic masses and 40 patients had malignant ovarian tumors. Using the criterion for TPS positivity defined by the manufacturer (80 U/L), TPS levels were elevated in 28.8% of benign pelvic mass patients and in 90% of malignant ovarian tumor patients. Statistical analysis using a two-by-two table at every cut-off TPS level and a receiver operating characteristic (ROC) curve, the optimal accuracy, sensitivity, specificity, positive predictive value, negative predictive value, false positive rate and false negative rate were 79.4, 90.0, 71.2, 70.6, 82.9, 28.9 and 10.0%, respectively using the positivity criterion of 80 U/L. We conclude that determination of serum TPS level by TPS ELISA in the diagnosis of ovarian malignancy is good and clinically acceptable. A TPS level greater than 80 U/L is a useful positivity criterion for screening for malignant ovarian tumors, while a TPS level greater than 180 U/L is a positivity criterion for differentiating malignant ovarian tumor from benign pelvic mass. Because of its high false positive rate, any patient with TPS greater than 80 U/L should be further investigated for malignant ovarian tumor.

Transvaginal color Doppler sonography and CA-125 elevation in a patient with ovarian thecoma and ascites.

A postmenopausal patient presented with a pelvic mass and ascites. The CA-125 level was 329 U/ml, and transvaginal color Doppler sonography of the tumor vasculature suggested malignancy. At laparotomy, a luteinized thecoma and cytologically benign ascites were found. On rare occasions ovarian thecoma may be associated with ascites without hydrothorax. Preoperative evaluation of the patient with ascites and a pelvic mass may suggest malignancy, but histologic confirmation is necessary to exclude this rare association.

[Serum testosterone level in the diagnosis of virilizing ovarian neoplasms]. / Uroven' syvorotochnogo testosterona v diagnostike viriliziruiushchikh opulkholei iaichnikov.

The paper is concerned with the results of investigation of 15 patients with virile ovarian tumors (VOT). The following methods were employed for instrumental diagnosis: USI, computerized tomography and laparoscopy. Hormonal investigation included the determination of basal levels of serum testosterone (T), excretion with urine of 17-ketosteroids and their time course against a background of suppression tests with dexamethasone and stimulation tests with CG. The results of hormonal investigations were compared with those of similar investigations of 14 patients with stromal ovarian thecomatosis and 8 patients with androgen producing adrenal tumors. Ovarian tumors were detected in 40% by instrumental and clinical methods. Hormonal studies revealed a high level of T in patients with virile ovarian and adrenal tumors exceeding 3-3.8-fold a similar indicator in patients with stromal thecomatosis. All patients with a "tumor" level of T underwent laparotomy after excluding an adrenal lesion. Ovarian tumors of 1.0-2.5 cm in diameter were detected.

[Serum estradiol as a marker in recurrent granulosa-theca-cell tumor]. / Serumøstradiol som markør ved recidiverende granulosa-thecacelltumor.

A case of a granulosa-theca-cell tumour of the ovary in a 39-year-old woman is reported. Despite benign histology and apparently radical operation, tumor growth relapsed twice before apparent cure. Oestradiol in serum proves valuable as a tumour marker and correlates well with tumour relapse.