Leydig cell tumor of the ovary in a postmenopausal woman presenting with virilization

Mild hyperandrogenism associated with anovulation or hirsutism is present in 5% of women. Severe hyperandrogenism associated with virilization is much less common. It may be caused by either benign or malignant neoplasms of adrenal or ovarian origin. We report a case of a virilizing steroid cell ovarian tumor in a 78-year-old postmenopausal woman. Although the biochemical evaluation pointed to an ovarian source of androgen, diagnostic attempts to localize the source of hyperandrogenism with transvaginal ultrasound and computed tomography scan of pelvis and abdomen failed. Venous sampling was considered, but the patient opted for bilateral salpingo-oophorectomy. Section of the right ovary revealed a well-demarcated tumor measuring 1.9 cm in greatest dimension. The tumor was composed of solid aggregates of polygonal cells with granular eosinophilic cytoplasm. Cytoplasmic lipofuscin was identified. Intracytoplasmic Reinke crystals were found. Within hours of surgery, biochemical markers of hyperandrogenism had resolved. This article reviews the clinical and biochemical presentation of tumorous ovarian virilization, histologic classification of ovarian virilizing tumors, currently used localization studies, including ovarian venous sampling, and concludes with a summary of therapeutic options for Leydig cell ovarian tumors.