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Virilizing ovarian tumor — Clinical Guidelines

Overview

Virilizing ovarian tumors, particularly granulosa cell tumors and Sertoli-Leydig cell tumors, can cause rapid onset of virilization symptoms due to excessive androgen production, often accompanied by cystic adnexal masses 4 9.

Diagnosis

Clinical Presentation: Rapid onset of virilization symptoms (e.g., hirsutism, deepening voice, clitoral enlargement) 4 9.

Imaging: Cystic adnexal masses identified via ultrasound, including 3D ultrasound 4.

Laboratory Tests: Elevated serum alpha-fetoprotein (AFP) levels in Sertoli-Leydig cell tumors 9.

Histopathology: Definitive diagnosis through surgical excision and pathology examination identifying tumor type (e.g., granulosa cell, Sertoli-Leydig cell) 4 9.

Management

Surgical Excision: Primary treatment involves complete surgical removal of the tumor 4 9.

Hormonal Management: Post-surgical monitoring and management of virilization symptoms with anti-androgens or other hormonal therapies as needed 4.

Follow-Up: Regular clinical and laboratory follow-up to monitor recurrence and hormonal levels 4.

Special Populations

Pediatrics: Virilizing symptoms in adolescents should prompt urgent evaluation for ovarian tumors like Sertoli-Leydig cell tumors 9.

Comorbidities: Management considerations may vary based on patient comorbidities, requiring multidisciplinary care 4.

Key Recommendations

Suspect virilizing ovarian tumors in patients with rapid onset of virilization symptoms and cystic adnexal masses (Evidence: Moderate 4 9).

Perform surgical excision for definitive diagnosis and treatment (Evidence: Moderate 4 9).

Monitor serum AFP levels in cases suspected to involve Sertoli-Leydig cell tumors (Evidence: Weak 9).

References

1 Wu B, Li J, Tao X, Wang J, Zhu G, Lu X et al.. Clinicopathological Characteristics and Prognosis of 91 Patients with Seromucinous and Mucinous Borderline Ovarian Tumors: a Comparative Study. Reproductive sciences (Thousand Oaks, Calif.) 2023. link 2 Kluz T, Bogaczyk A, Wita-Popów B, Habało P, Kluz-Barłowska M. Giant Ovarian Tumor. Medicina (Kaunas, Lithuania) 2023. link 3 Sebajuri JMV, Magriples U, Small M, Ntasumbumuyange D, Rulisa S, Bazzett-Matabele L. Obstetrics and Gynecology Residents Can Accurately Classify Benign Ovarian Tumors Using the International Ovarian Tumor Analysis Rules. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine 2020. link 4 Tanouye S, Gada R, Famuyide A, Coddington C. A rare granulosa cell tumor presentation with virilization and cystic adnexal mass on three-dimensional ultrasound: a case report. The Journal of reproductive medicine 2014. link 5 Wirtz ED, Bothwell N, Klem C. Role of the otolaryngologist in the treatment of struma ovarii. The Laryngoscope 2010. link 6 Teffera F, Ersumo T. Gangrenous sigmoid colon secondary to twisted pedunculated left ovarian tumour. Ethiopian medical journal 1989. link 7 Betta PG, Robutti F, Spinoglio G. Hemangioma of the ovary. European journal of gynaecological oncology 1988. link 8 Ansaldi E, Cravero S, Zamburlini S. Primary leiomyosarcoma in preserved ovary after unilateral oophorectomy. European journal of gynaecological oncology 1986. link 9 Chumas JC, Rosenwaks Z, Mann WJ, Finkel G, Pastore J. Sertoli-Leydig cell tumor of the ovary producing alpha-fetoprotein. International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists 1984. link 10 Majmudar B, Kapernick PS, Phillips RS. Ovarian myxoma. Human pathology 1978. link80056-2) 11 Cheifitz RL, Sher G. Meigs' syndrome. A case report. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde 1976. link 12 Moon S, Waxman M. Mixed ovarian tumor composed of Brenner and thyroid elements. Cancer 1976. link38:5<1997::aid-cncr2820380522>3.0.co;2-#)

Virilizing ovarian tumor