McGee J, Fleming N A, Senterman M, Black A Y
Department of Obstetrics and Gynecology, The Ottawa Hospital, Ottawa, Ontario, Canada.
J Pediatr Adolesc Gynecol. 2009 Oct;22(5):e107-10. doi: 10.1016/j.jpag.2008.06.002. Epub 2009 Jul 3.
Only 30% of luteinized thecomas are found in women under the age of 30, and they are typically benign. Only 11% of luteinized thecomas show clinical signs of androgen production. We present an unusual case of a 15-year-old female who presented with secondary amenorrhea and virilization and was subsequently diagnosed with a benign luteinized thecoma of the ovary. This is the youngest nonmalignant luteinized thecoma reported to date.
A 15-year-old Sri Lankan female presented with increasing hair growth, a hoarse voice, and secondary amenorrhea. On physical examination, there was marked hirsutism and clitoromegaly. Investigations found an elevated free testosterone level and an enlarged, homogenous left ovary with absent normal ovarian architecture. A laparotomy and unilateral salpingo-oophorectomy was performed. The final diagnosis was a luteinized ovarian thecoma, with no evidence of malignancy. Postoperatively, testosterone levels normalized and menstrual cycles resumed. Although laser treatment helped with her hirsutism, her other virilizing symptoms (deepening of voice, clitoromegaly) did not improve postoperatively.
This case of a virilizing ovarian luteinized thecoma emphasizes the need for timely evaluation, diagnosis, and treatment of patients presenting with symptoms of excess androgen secretion in order to avoid irreversible unwanted effects. Possible ovarian causes of excess androgen secretion should not be overlooked when considering possible causes of hyperandrogenism and secondary amenorrhea.
仅30%的黄素化卵泡膜瘤见于30岁以下女性，且通常为良性。仅11%的黄素化卵泡膜瘤有雄激素产生的临床体征。我们报告一例罕见病例，一名15岁女性出现继发性闭经和男性化表现，随后被诊断为卵巢良性黄素化卵泡膜瘤。这是迄今为止报道的最年轻的非恶性黄素化卵泡膜瘤。
一名15岁斯里兰卡女性出现毛发增多、声音嘶哑和继发性闭经。体格检查发现明显多毛和阴蒂增大。检查发现游离睾酮水平升高，左侧卵巢增大、均质，正常卵巢结构消失。行剖腹手术及单侧输卵管卵巢切除术。最终诊断为黄素化卵巢卵泡膜瘤，无恶性证据。术后，睾酮水平恢复正常，月经周期恢复。尽管激光治疗有助于改善多毛症状，但术后她的其他男性化症状（声音变粗、阴蒂增大）并未改善。
这例男性化卵巢黄素化卵泡膜瘤病例强调，对于出现雄激素分泌过多症状的患者，需要及时评估、诊断和治疗，以避免不可逆的不良影响。在考虑高雄激素血症和继发性闭经的可能原因时，不应忽视卵巢可能导致雄激素分泌过多的原因。
