Virilizing ovarian dermoid cyst with leydig cells

Area of Science:

• Reproductive Endocrinology
• Gynecologic Oncology
• Pediatric Endocrinology

Background:

• Virilization in females is uncommon, with ovarian tumors being a rare cause, typically seen in post-menopausal women.
• Benign cystic teratomas (dermoid cysts) are the most common ovarian germ cell tumors, usually asymptomatic.
• No prior cases reported virilization from a testosterone-producing ovarian dermoid in adolescent females.

Observation:

• A 12-year-old female presented with signs of masculinization, including voice deepening and clitoromegaly.
• Imaging revealed a large (35x19x12 cm) ovarian mature cystic teratoma of the right ovary.
• Pathological examination identified a nest of Leydig cells within the teratoma, producing significant amounts of testosterone.

Findings:

• This case represents the first reported instance of virilization due to a testosterone-producing ovarian dermoid in an adolescent female.
• The teratoma actively secreted testosterone, leading to the observed clinical signs of masculinization.
• Benign cystic teratomas, while typically non-functional, can rarely exhibit hormone production.

Implications:

• Clinicians should consider the potential for hormone production in benign cystic teratomas, even in young patients.
• Ovarian cystectomy for benign cystic teratomas requires careful pathological assessment for hormone-secreting cells.
• This finding expands the differential diagnosis for pediatric virilization and emphasizes rare complications of common ovarian neoplasms.