EP22.30: Virilisation by an ovarian tumour: sonographic appearance of a small Leydig cell tumour

Sertoli cell tumours, Sertoli–Leydig cell tumours (SLCTs), and Leydig cell tumours are rare tumours of the ovary which may have endocrine manifestations. On ultrasound they may appear as solid unilateral ovarian lesions. A 39 yo woman was referred to our centre with secondary amenorrhea for years, hirsutism, and clitoromegaly (see figure 1a–b). Laboratory tests showed serum testosterone at 9.82 ng/dl and free testosterone at 48.7 pg/ml. Ultrasound examination showed a unilateral solid rounded hypoechoic lesion measuring 19x14x16 mm, with regular margins, moderately vascularised at power Doppler examination (CS3) within the right ovary (see figure 1c–d). The lesion appeared iso-hyperintenseon T2 fat sat weighted images on MRI (see figure 1e). With the suspicion of ovarian sex cord stromal-tumour, a laparoscopic right salpingo-oophorectomy was performed. Final pathology showed a Leydig cell tumour in the right ovary (see figure 1f), stage IA FIGO. A month after surgery, a hormonal assessment showed a return to normal testosterone levels, as well as diminishing hirsutism and resumption of regular menstrual cycles. Leydig cell tumours are rare, nearly all benign, and often associated with hirsutism and virilisation. They are unilateral and have a small diameter (mean 2.4cm) compared to SLCTs and Sertoli tumours (mean diameters of 5-15cm and 9cm, respectively). In our case, clinical and sonographic characteristics of the tumour agreed with those previously described for Leydig cell tumours, displaying unilaterality and solid morphology with regular margins, a very small diameter, and moderate to high vascularisation at colour Doppler. A conservative surgical treatment was performed to preserve fertility. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.