Rajamani Krishnakumar, Moore Richard G, Stanard Sheena M, Astapova Olga
Rochester Regional Health, 100 Kings Highway South, Rochester, New York.
University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York.
AACE Clin Case Rep. 2022 Jan 25;8(3):135-138. doi: 10.1016/j.aace.2022.01.003. eCollection 2022 May-Jun.
BACKGROUND/OBJECTIVE: Epithelial cell ovarian carcinomas rarely secrete steroid hormones, while sex cord and stromal cell ovarian carcinomas often do so. The objective of this report is to describe a patient with endometrioid ovarian carcinoma, an epithelial cell tumor, who presented with hyperandrogenism due to testosterone production by the tumor.
A 67-year-old postmenopausal woman with no history of endometriosis presented with new onset of hirsutism. Her testosterone level was 282 ng/dL (8-60 ng/dL), estradiol level was 72 pg/mL (≤32.2 pg/mL), and 17-hydroxyprogesterone level was 592 ng/dL (≤45 ng/dL). Pelvic ultrasound showed a right adnexal mass measuring 14.7 × 9.7 × 12.3 cm and an endometrial thickness of 9 mm with calcifications within the endometrium. Human epididymis protein 4 level was 210 pmol/L (0-140 pmol/L), and cancer antigen 125 level was 144 U/mL (0-34 U/mL). The patient underwent exploratory laparotomy with removal of the pelvic mass. Pathology showed an endometrioid adenocarcinoma with positive immunohistochemistry staining for the following steroidogenic enzymes: side-chain cleavage enzyme, 17α-hydroxylase, and aromatase. There was no evidence of tumor metastases within the pelvic cavity. Ovarian tumor markers normalized and remained stable 1 year after surgery.
Although endometrioid ovarian carcinomas do not typically produce clinically significant levels of sex steroids, in rare cases, these tumors can do so, leading to symptoms and promoting early detection and treatment of the cancer.
Sex hormone secretion by epithelial cell ovarian carcinomas should be considered in cases of new-onset steroid hormone excess in postmenopausal women.
背景/目的：上皮细胞性卵巢癌很少分泌甾体激素，而性索间质细胞性卵巢癌则常常分泌。本报告的目的是描述一名患有子宫内膜样卵巢癌（一种上皮细胞肿瘤）的患者，该肿瘤因产生睾酮而导致高雄激素血症。
一名67岁绝经后女性，无子宫内膜异位症病史，出现新发多毛症。她的睾酮水平为282 ng/dL（8 - 60 ng/dL），雌二醇水平为72 pg/mL（≤32.2 pg/mL），17 - 羟孕酮水平为592 ng/dL（≤45 ng/dL）。盆腔超声显示右侧附件区有一大小为14.7×9.7×12.3 cm的包块，子宫内膜厚度为9 mm，内膜内有钙化。人附睾蛋白4水平为210 pmol/L（0 - 140 pmol/L），癌抗原125水平为144 U/mL（0 - 34 U/mL）。患者接受了探查性剖腹手术并切除盆腔包块。病理显示为子宫内膜样腺癌，对以下甾体生成酶的免疫组化染色呈阳性：侧链裂解酶、17α - 羟化酶和芳香化酶。盆腔内无肿瘤转移证据。术后1年卵巢肿瘤标志物恢复正常并保持稳定。
尽管子宫内膜样卵巢癌通常不会产生具有临床意义的性甾体水平，但在罕见情况下，这些肿瘤可以产生，从而导致症状并促进癌症的早期发现和治疗。
绝经后女性出现新发甾体激素过多的情况时，应考虑上皮细胞性卵巢癌分泌性激素的可能性。
