- MeSH
- kongenitální adrenální hyperplazie * etiologie klasifikace patofyziologie patologie MeSH
- lidé MeSH
- novorozenec MeSH
- virilizace etiologie patofyziologie patologie vrozené MeSH
- Check Tag
- lidé MeSH
- novorozenec MeSH
- Publikační typ
- přehledy MeSH
Leydig cell tumours of the ovary are rare and represent a diagnostic challenge not only due to their sporadic incidence but also due to the seemingly normal imaging. We present three cases of pre- and postmenopausal women who were presented with severe clinical signs of hyperandogenism where modern imaging modalities (including computed tomography (CT), magnetic resonance imaging (MRI) and positron-emission tomography combined with computed tomography (PET-CT)) failed to identify the tumour. Two patients underwent non-expert ultrasound, CT and MRI examination with uniform conclusion that ovaries are of normal appearance. One of the two patients even had a PET-CT performed, which was inconclusive. Our case reports show the importance of examination by specialists with established skills in gynaecologic ultrasonography in the diagnosis of the Leydig cell tumours. The most useful diagnostic tool seems to be the combination of age (postmenopause), symptoms (onset of hirsutism and virilisation), high total testosterone plasma values and expert sonography. On ultrasound, these tumours are unilateral, usually small, solid intraovarian nodules of a slightly increased echogenicity in contrast to the surrounding ovarian tissue, delineated by abundant perfusion with an enhanced vascularity. The appropriate setting of the sensitive colour Doppler is crucial for the detection of intraovarian Leydig cell tumour. Impact statement What is already known on this subject? A diagnosis of Leydig cell tumours is based on ultrasound performed by a trained examiner or by MRI. CT or PET/CT are not among the primary methods of choice. According to the results of imaging investigations surgical treatment is planned. Because these tumours are usually benign and have a good prognosis the unilateral salpingo-oophorectomy is a standard procedure. What do the results of this study add? Our case series show how difficult it can be to establish the diagnosis of Leydig cell tumours by imaging, including transvaginal ultrasound, the most frequently recommended diagnostic tool. We demonstrate in three cases how easily a small hyperechogenic tumour can be overseen or interchanged for a different gynaecological pathology if transvaginal scan is not performed by an experienced examiner trained in sonographic features of gynaecologic neoplasms. What are the implications of these findings for clinical practice and/or further research? This case series demonstrate how important it is to see the patient in the whole complexity with their medical history, proper clinical symptoms evaluation, laboratory test and not to rely solely just on sophisticated high-end investigations, such as the PET-CT, a CT and an MRI. It also emphasises the importance of specialists with established skills in gynaecologic ultrasonography. Further effort should be made to define the resources for the appropriate training of such sonographers.
- MeSH
- amenorea etiologie MeSH
- hirzutismus etiologie MeSH
- hysterektomie vaginální MeSH
- lidé středního věku MeSH
- lidé MeSH
- magnetická rezonanční tomografie MeSH
- nádor z Leydigových buněk diagnostické zobrazování patologie chirurgie MeSH
- nádory vaječníků diagnostické zobrazování patologie chirurgie MeSH
- ovarektomie MeSH
- PET/CT MeSH
- testosteron krev MeSH
- ultrasonografie dopplerovská barevná MeSH
- virilizace etiologie MeSH
- Check Tag
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- kazuistiky MeSH
Hypertestosteronizmus ako súčasť hyperandogénnych stavov u žien je všeobecne definovaný ako nadbytok mužských hormónov (v tomto prípade testosterónu). Spektrum klinických príznakov zahŕňa okrem porúch menštruácie až amenoreu, rôzne stupne hirzutizmu a virilizáciu. Tento raritný tumor produkuje veľké množstvo testosterónu, ale aj jeho prekurzor androstendión. Najčastejšie sa tento tumor vyskytuje v období medzi 20.–40. rokom života, ale aj v postmenopauzálnom období. Liečba je zásadne chirurgická, s postupnou úpravou hormonálneho statusu pacientov.
Hypertestosteronism as part of hyperandrogenic states in women is generally defined as abundance of male hormones (in this case abundance of testosterone). Spectrum of clinical symptoms include menstrual disorders, amenorrhoea, different range of hirsutism and virilization. Statistically, most androgen secreting tumors are ovarian aetiology (testosterone secreting tumors located in suprarenal gland are very rare). This rare tumor may produce excess amounts of testosterone, as well as its precursor androstenedione. The highest incidence is between 20–40 years and in postmenopausal period. The treatment is essentially surgical; with gradual adjustment of the hormones.
- Klíčová slova
- nádory produkující androgeny,
- MeSH
- hirzutismus etiologie MeSH
- hyperandrogenismus * diagnóza etiologie terapie MeSH
- lidé MeSH
- nádory vaječníků * diagnóza chirurgie patologie MeSH
- senioři MeSH
- testosteron krev MeSH
- virilizace * etiologie MeSH
- Check Tag
- lidé MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
- práce podpořená grantem MeSH
- MeSH
- adenom kůry nadledvin metabolismus ultrasonografie MeSH
- adrenokortikální karcinom metabolismus ultrasonografie MeSH
- androgeny biosyntéza fyziologie MeSH
- aromatasa nedostatek MeSH
- dospělí MeSH
- financování organizované MeSH
- hyperandrogenismus komplikace metabolismus ultrasonografie MeSH
- komplikace těhotenství metabolismus ultrasonografie MeSH
- lidé MeSH
- luteom metabolismus ultrasonografie MeSH
- nadledviny metabolismus ultrasonografie MeSH
- nádory nadledvin metabolismus MeSH
- nádory vaječníků metabolismus ultrasonografie MeSH
- ovarium metabolismus ultrasonografie MeSH
- placenta enzymologie MeSH
- plod metabolismus MeSH
- těhotenství MeSH
- ultrasonografie prenatální MeSH
- virilizace etiologie metabolismus ultrasonografie MeSH
- Check Tag
- dospělí MeSH
- lidé MeSH
- těhotenství MeSH
- ženské pohlaví MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- amenorea etiologie terapie MeSH
- laparoskopie metody využití MeSH
- lidé MeSH
- mladiství MeSH
- nádory vaječníků etiologie chirurgie ultrastruktura MeSH
- virilizace etiologie terapie MeSH
- Check Tag
- lidé MeSH
- mladiství MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
