Virilizing Ovarian Tumor in a Postmenopausal Women

Aim and background: Postmenopausal hyperandrogenism is a state of relative or absolute androgen excess originating from the adrenal glands and/or ovaries.It is clinically manifested by the presence of terminal hair in androgen-dependent areas of the body, acne, androgenic alopecia, voice change, changes in libido etc.One must exclude the possibility of rare but serious androgen-producing tumors of the adrenal glands or ovaries when postmenopausal women come with such symptoms.Measurement of serum testosterone, sex hormone-binding globulin, dehydroepiandrosterone sulfate, androstenedione and inhibin B support the diagnosis of hyperandrogenism.Case description: A 63-year-old multiparous woman presented with complaints of hoarseness of voice, male-patterned baldness and hirsutism.She underwent an abdomino-pelvic ultrasound scan showing features of hyperechoic enlarged ovaries, atrophic uterus with thin endometrium.With a suspicion of solid ovarian tumor on scan, tumor markers were done for which revealed increased levels of serum testosterone.In order to confirm the diagnosis magnetic resonance imaging (MRI) was done which stated bilateral solid ovarian tumor.Decision was taken for total laparoscopic hysterectomy with bilateral sapling oophorectomy done and sample sent for frozen section which revealed ovarian fibroma.Conclusion and clinical significance: Most of ovarian fibromas/fibro thecomas occur in adolescents and young women and show a solid pelvic or adnexal mass with benign bio behavior.The most common sign is unilaterally asymptomatic pelvic mass.Ovarian fibromas/fibrothecoma is occasionally combined with elevated serum CA125 level, and such a condition is easily misdiagnosed as ovarian epithelial carcinoma.Gynecologists should be aware of the clinical features of this unusual ovarian tumor, and conservative surgery and intraoperative frozen section are an option, especially for the patients with the reproductive age.