Virilizing ovarian tumor: the challenges of differential diagnosis

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Abstract


Sertoli–Leydig cell tumor is a rather rare type of ovarian neoplasms belonging to the group of sex cord–stromal tumors. This malignancy is characterized by androgen overproduction, which results in the so-called virilization and can be accompanied by various metabolic disorders such as abdominal obesity, disturbances of carbohydrate and protein metabolism, and high blood pressure.

During differential diagnosis, it is important to identify the source of androgen overproduction. An androgen-secreting ovarian tumor needs to be differentiated from androgen-secreting adrenal tumor, ovarian stromal thecomatosis (hyperthecosis), and endogenous hypercorticism (the Cushing’s syndrome). In most cases, the Sertoli–Leydig cell tumor is associated with DICER1 mutation carriership. If a patient is found to carry the DICER1 mutation, patient’s relatives need to undergo genetic testing as the individuals with mutations in this gene have an elevated risk of developing a broad range of benign and malignant tumors (most of these tumors are relatively rare in the overall population).

The awareness of this rare ovarian neoplasm among medical specialists (obstetricians–gynecologists, endocrinologists, and oncologists) is supposed to ensure timely diagnosis and adequate treatment of this disease.


Marina F. Kalashnikova

I.M. Sechenov First Moscow State Medical University

Email: marina_kalash@mail.ru
ORCID iD: 0000-0002-7924-8687
SPIN-code: 3777-4087

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD, associate professor

Natalia V. Likhodey

I.M. Sechenov First Moscow State Medical University

Email: nettle_l@yahoo.com
ORCID iD: 0000-0002-4680-0746
SPIN-code: 4022-9955

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD

Anatoly N. Tiulpakov

Endocrinology Research Centre

Email: anatolytiulpakov@gmail.com
ORCID iD: 0000-0001-8500-4841
SPIN-code: 8396-1798

Russian Federation, 11 Dm. Ulyanova street, 117036 Moscow

MD, PhD

Evgeniya V. Fedorova

I.M. Sechenov First Moscow State Medical University

Email: ev.fedorova@mail.ru
ORCID iD: 0000-0002-3013-5139

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD, associate professor

Dmitry V. Bryunin

I.M. Sechenov First Moscow State Medical University

Email: brun777@mail.ru
ORCID iD: 0000-0002-5969-4217
SPIN-code: 1439-3731

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD, Professor

Alla A. Bakhvalova

I.M. Sechenov First Moscow State Medical University

Email: allbak0202@yandex.ru
ORCID iD: 0000-0002-3966-3296

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD

Maria A. Glushakova

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
Email: mariaglushakova@yandex.ru
ORCID iD: 0000-0001-6457-663X
SPIN-code: 9435-9432

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

student 6 course  Medical Faculty

Svetlana A. Smirnova

I.M. Sechenov First Moscow State Medical University

Email: svetlana.gorl@yandex.ru
ORCID iD: 0000-0001-5625-3136
SPIN-code: 7854-8891

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

student 6 course  Medical Faculty

Valentin V. Fadeyev

I.M. Sechenov First Moscow State Medical University

Email: walfad@mail.ru
ORCID iD: 0000-0002-2504-7468
SPIN-code: 6825-8417

Russian Federation, 8-2, Trubetskaya street, Moscow, 119992

MD, PhD, Professor

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Supplementary files

Supplementary Files Action
1. Fig. 1. Appearance of patient Sh. Before surgery - excessive hair growth on the face and body. View (160KB) Indexing metadata
2. Fig. 2. Appearance of patient Sh. Before surgery - hyperemia and acne on the back, hair loss on the head, excessive development of subcutaneous fat on the abdomen. View (106KB) Indexing metadata
3. Fig. 3. Ultrasound of the pelvic organs. The increase in size and structural changes in the left ovary (43 × 27 × 42 mm). Enlarged uterus (61 × 52 × 75 mm), uterine fibroids of different sizes. View (139KB) Indexing metadata
4. Fig. 4. Highly differentiated ovarian tumor from Sertoli – Leydig cells. Stained with hematoxylin and eosin, × 50. View (293KB) Indexing metadata
5. Fig. 5. Appearance of patient Sh. 2 years after surgery - the absence of acne on the face. View (84KB) Indexing metadata
6. Fig. 6. Appearance of patient Sh. 2 years after the operation - the absence of acne rashes, hair growth on the back. View (109KB) Indexing metadata
7. Fig. 7. Appearance of patient Sh. 2 years after surgery - the absence of acne, hair growth on the chest, on the abdomen. View (131KB) Indexing metadata

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Copyright (c) 2019 Kalashnikova M.F., Likhodey N.V., Tiulpakov A.N., Fedorova E.V., Bryunin D.V., Bakhvalova A.A., Glushakova M.A., Smirnova S.A., Fadeyev V.V.

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