Massive ovarian edema with androgen secretion. A pathological and endocrine study with review of the literature

A case of massive edema of the left ovary with virilization is described. Microscopically, massive interstitial edema with luteinization of theca and stromal cells was found. A few stromal cells contained Reinke-type crystalloids--an original observation. Peripheral concentrations of testosterone, dihydrotestosterone and androstenedione were increased. Ratios of left ovarian vein to peripheral vein concentrations were increased for all these steroids as well as for estradiol and estrone, showing that the left ovary was the source of excess androgen and estrogen secretion. The patient showed impaired gonadotropin secretion in basal conditions and after an intravenous luteinizing-hormone-releasing hormone (LHRH) stimulation test. After left oophorectomy, all steroids and gonadotropin response to LHRH returned to normal, and virilization regressed. Analysis of the endocrine changes associated with this ovarian tumor brings additional arguments for a primary role of hyperandrogenism in the impairment of gonadotropin secretion, as was also observed in other hyperandrogenic disorders including polycystic ovarian syndrome.