DOI:10.2214/AJR.06.0867
AJR 2007; 188:W393-W394
© American Roentgen Ray Society
Steroid Cell Tumor of the Ovary, Not Otherwise Specified: CT and MR Findings
Tsukasa Saida,
Yumiko Tanaka and
Manabu Minami
Tsukuba Medical Center Hospital, University of Tsukuba, Tsukuba,
Ibaraki, Japan
WEB—This is a Web exclusive article.
A 28-year-old woman was referred to our hospital with increasing hirsutism,
acne, deepening voice, and clitoromegaly for more than 1 year. The levels of
serum testosterone, free testosterone, and progesterone were 1.66 (reference
range, 0.13-0.69 ng/mL), 3.2 (0-2.7 ng/mL), and 7.09 (0-31.6 ng/mL),
respectively. Endovaginal sonography images showed a solid tumor with multiple
cysts replacing the left ovary. MR images showed a multilocular cystic mass
having a nodular wall and containing fluid of varying signal intensities
(Fig. 1A). The nodular wall was
moderately enhanced during the early phase of the dynamic contrast-enhanced
study. Fat-saturated T1-weighted MR images revealed no signal loss due to
lipid components. The nodular wall was low in density (30 H) and was difficult
to distinguish from the liquid within the locules on unenhanced CT images
(Figs. 1B and
1C). No lymph node swelling or
intraperitoneal dissemination was identified. The preoperative diagnosis was
testosterone-producing sex-cord stromal cell tumor. However, the
characteristics of the mass were different from those of Sertoli stromal cell
tumors, which usually show an enhancing solid mass. A left
salpingo-oophorectomy was performed and the serum levels of testosterone
returned to normal immediately after the surgery.
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Fig. 1A —28-year-old woman with steroid cell tumor of ovary. Sagittal
T2-weighted MR image (fast spin-echo; TR/TE, 1,900/100) shows multilocular
cystic mass in front of uterus, which contains fluid of varying signal
intensities and shows nodular wall.
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The cut surface of the specimen showed a multilocular cystic mass including
serous, myxoid, hemorrhagic, and necrotic contents with calcific deposits. The
peripheral nodular wall was composed of yellowish solid tissue.
Microscopically, diffusely arranged tumor cells proliferated in nests and
sheets with sparse, delicate stroma. The tumor was composed of two different
types of cells; one contained abundant intracytoplasmic lipids and the other
contained eosinophilic cytoplasm (Fig.
1D). Four mitotic figures per 10 high-power fields were also seen.
The histopathologic diagnosis was a steroid cell tumor, not otherwise
specified, with borderline malignancy.
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Fig. 1D —28-year-old woman with steroid cell tumor of ovary. Photomicrograph
shows lipid-rich cells with spongy cytoplasm and lipid-poor cells with
granular eosinophilic cytoplasm. (H and E, x20)
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Ovarian steroid cell tumors are characterized by cells with abundant
intracellular lipids, which are similar to adrenocortical cells. They account
for 0.1-0.2% of all ovarian tumors, and the majority of them show virilization
[1]. There are three subtypes:
stromal luteoma; Leydig cell tumor; and steroid cell tumor, not otherwise
specified. Steroid cell tumor, not otherwise specified, accounts for
approximately 60% of steroid cell tumors, 25-45% of which are clinically
malignant [1,
2]. Half of the cases with this
subtype are associated with androgenic changes. Steroid cell tumors often
present as unilateral solid tumors and occasionally as cystic tumors. Necrosis
or calcification is frequently associated.
CT and MRI characteristics of steroid cell tumors are variable owing to the
amount of lipid components and fibrous stroma
[1,
2]. However, the tumors show
intense enhancement on MRI, reflecting the hypervascularity. Tumors causing
virilization are often small
[1,
3]. In our case, the tumor
showed a large cystic mass with a nodular wall and without apparent lipid
components. However, the hypointense nodular wall on CT might be attributable
to lipid contents [3,
4]. Chemical shift MRI, which
was not performed in our case, might be helpful for identifying intra-cellular
lipids. Although, minimal fat-containing teratoma and thecoma, Sertoli stromal
cell tumors, and clear cell carcinoma can also exhibit a drop out of phase
sequences, we recommend performing chemical shift MRI in differentiating
testosterone producing ovarian tumors.
References
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