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Symptomatic Cushing syndrome and hyperandrogenemia revealing steroid cell ovarian neoplasm with late intra-abdominal metastasis.
[cushing syndrome]
Steroid
cell
tumors
of
ovary
account
for
less
than
0
.
1
%
of
all
ovarian
tumors
and
these
tumours
may
present
at
any
age
in
association
with
interesting
presentations
related
to
hormonal
activities
.
The
subtype
,
not
otherwise
specified
(
NOS
)
,
is
associated
with
androgenic
changes
in
56
-
77
%
and
Cushing
syndrome
in
6
-
10
%
.
Due
to
the
rarity
of
available
data
regarding
these
tumors
,
little
is
known
about
their
malignant
potential
and
metastatic
behaviour
.
We
hereby
report
an
unusual
metastasis
of
steroid
cell
ovarian
neoplasm
presented
with
both
Cushing
syndrome
and
hyperandrogenemia
.
A
31
-
year
-old
woman
,
who
had
a
past
medical
history
of
ovarian
tumor
resection
(
left
ovarian
thecoma
was
initially
diagnosed
at
that
time
)
,
presented
with
hirsutism
,
hypertension
and
menstrual
disorder
.
Also
,
laboratory
work-up
revealed
hypercortisolism
and
androgen
excess
.
Computerized
tomography
(
CT
)
of
the
abdomen
showed
abdominal
paraaortic
masses
,
multiple
intrahepatic
nodules
and
retroperitoneal
lymph
nodes
enlargement
.
Positron
emission
tomography
/
computed
tomography
(
PET
/
CT
)
scan
demonstrated
metastatic
lesions
.
Her
ovarian
tumor
sections
were
re
-examined
and
pathology
result
was
corrected
to
steroid
cell
tumor
(
NOS
)
associated
with
active
cell
growth
and
necrosis
.
Subsequent
excision
of
metastatic
lesions
yielded
clinical
improvement
promptly
and
metastasis
of
steroid
cell
tumor
was
confirmed
by
postoperative
pathological
studies
.
However
,
one
year
after
the
surgical
management
of
metastasis
,
recurrence
happened
while
radiotherapy
was
ineffective
.
The
patient
finally
died
of
tumor
metastatic
recurrence
.
This
case
reports
a
rare
coexistence
of
Cushing
syndrome
and
hyperandrogenemia
which
occurs
based
on
metastasis
of
steroid
cell
ovarian
neoplasm
.
It
presents
a
real
diagnostic
challenge
to
both
clinicians
and
pathologists
.
Therefore
,
it
is
very
important
to
establish
a
final
diagnosis
by
pathological
studies
along
with
clinical
manifestations
and
imaging
findings
.
Besides
,
it
is
necessary
to
improve
follow-up
of
patients
with
this
kind
of
tumors
.
Diseases
Validation
Diseases presenting
"hirsutism"
symptom
aromatase deficiency
coats disease
congenital adrenal hyperplasia
cushing syndrome
kabuki syndrome
monosomy 21
This symptom has already been validated