Testosterone-producing ovarian tumors: a clinical study of 25 cases

摘要

Objective: To study the clinical characteristics of testosterone-producing ovarian tumors.Methods: Twenty-five patients with testosterone-producing ovarian tumors diagnosed pathologically were treated in Peking Union Medical College Hospital from Jan 1986 to Oct 2006.Clinical documents of the 25cases wereanalyzed retrospectively.Results: (1)The median age of patients was 27 years.Menstrual irregularity was seen in 96% of patients and virilization was seen in 100%.(2) Endocrinological tests: Total testosterone, LH, FSH, LH/FSH, E2 in serum before and after operation were 16.9±6.8/1.0±1.6 nmol/L(P=0.000) ,6.6±3.41/11.7±6.8 IU/L(P=0.025) ,4.9±2.6/9.2±7.8 IU/L(P=0.072),2.1±2.5/1.7±1.0(P=0.579),241±139/164±161 pmol/L(P=0.131),respectively.Initial investigation showed the level of E2 was in early follicle stage in 86 % of patients, normal level of ACTH in 92% ,increased level of 17-αOHP and F in 50 % and in 22 % of patients, respectively, all patients have normal urinary free cortisol collected over a 24-hour period.Dexamethasone suppression tests and ACTH stimulating tests suggested non-adrenocorticotrophic homone dependency of the hyperandrogenic state.(3) Pathological features:of all tumors,60% were Sertoli-Leydig cell tumors in which 67% of them were poor differentiated, 32% were lipid cell tumors in which all of them were well differentiated.All tumors were unilateral.The median size of tumors was 4.8cm.On cut surface most of them were solid and yellow.(4)Treatment and prognosis:twenty-two younger patients were performed conservative staging surgery.Patients with poor-differentiated tumors accepted chemotherapy and GnRH-a.After removal of ovarian tumors, symptoms of virilization were improved and five patients had healthy children.Conclusions: Testosterone-producing ovarian tumors are often seen in reproductive ages.They produce defeminization followed by virilization.The total level of testosterone in serum was increased markedly while decreased rapidly after removal of tumor.Owing to their relatively small size, the detection of such tumors may be difficult.Sertoli-Leydig cell and lipid cell tumors are the common pathological types.Total hysterectomy with bilateral salpingo-oophorectomy is the treatment of choice in postmenopausal women.In yonger women, resection of the tumor or unilateral salpingo-oophorectomy is preferable to preserve fertility.The prognosis of these tumors is satisfactory after treatment,but patients should be followed-up regularly.