Endocrine Abstracts

Background: Ovarian mucinous cystadenomas are classically considered as ‘non-functional’ tumors. Cystadenomas are among the most common benign ovarian neoplasms. Compared with serous cystadenomas, mucinous cystadenomas occur less frequently, are more often unilateral and can attain an enormous size. Most of these tumors are asymptomatic and found incidentally on pelvic examination or with ultrasound. We present an unusual case of a mucinous cystadenoma presenting with severe virilization in a 71-year old woman.

Case: A 71-year old female was referred to our out-patient endocrinology clinic because of rapid progressive androgenic alopecia, clitoromegaly and male pattern pubic hair growth since one year. Her medical history was unremarkable. Serum level of testosterone was 3.35 µg/l (normal range < 0.4 µg/l) and the dihydroepiandrosterone sulfate (DHEAS) level was 267 µg/l (normal range 100–800 µg/l). Magnetic resonance imaging of the abdomen revealed a 5.5 × 3 × 3 cm cystic ovarian mass. A bilateral salpingo-oophorectomy was performed without complications. Histopathology showed an unilocular cystic structure with a yellowish content and compatible with a mucinous cystadenoma. Postoperative testosteron levels quickly normalised (< 0.4 µg/l).

Discussion: Rapidly developing postmenopausal hyperandrogenism easily turns into a diagnostic challenge for the clinician. Most cases result from adrenal or ovarian tumors but atypical causes must be recognized as well. To date and to the best of our knowledge there are only five cases of mucinous adenoma causing virilization in postmenopausal women identified in the literature.

This sixth case adds strength to the link between ovarian mucinous cystadenoma and severe, rapidly progressive hyperandrogenism during menopause. In this case surgical resection is the treatment of choice.