Virilization due to a metastasizing granulosa cell tumor.

This report describes a virilizing granulosa cell tumor in a postmenopausal woman. The tumor metastasized to the liver, urinary bladder, and spinal column. Although the bladder metastases were diagnosed initially as paraganglioma, review of the slides and the demonstration of abundant lipid within the tumor cells led to the correct diagnosis. The plasma testosterone and 17-hydroxyprogesterone levels were elevated, while the plasma 17-hydroxypregnenolone and dehydroepiandrosterone levels were normal, suggesting that the delta 4-pathway of testosterone biosynthesis was predominant in this tumor. Gonadotropin levels were suppressed and did not respond to gonadotropin-releasing hormone. Presumably, this suppression was due to an increase in the plasma testosterone level.