Bilateral ovarian capillary hemangioma with stromal luteinization and hyperandrogenism

A 77-year-old female presented to the outpatient clinic with a six-month history of left lower quadrant abdominal fullness and pressure. Serum levels included free testosterone 3.8 pg/mL (normal 0-1.8 pg/mL) and testosterone 259 ng/dL (normal 3-41 ng/dL). Magnetic resonance imaging of the pelvis showed bilateral small ovarian cystic masses with marked, progressive enhancement, and restriction of diffusion. Laparoscopic bilateral salpingo-oophorectomy was performed and showed left and right ovarian hemorrhagic masses measuring 2.1 cm and 0.6 cm respectively. The histology showed benign vascular lesions composed of small capillary vessels with a rim of luteinized stromal cells. The luteinized cells were strongly positive for inhibin A. The endothelial cells were negative for estrogen receptor and progesterone receptor. To our knowledge, this is the first reported case of bilateral ovarian hemangioma with stromal luteinization and hyperandrogenism.