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SULTAN QABOOS UNIVERSITY MEDICAL JOURNAL 
NOVEMBER 2008, VOLUME 8, ISSUE 3, P. 358-359
SULTAN QABOOS UNIVERSITY©
SUBMITTED - 5TH APRIL 2008
ACCEPTED - 25TH JULY 2008

Steroid Cell Tumor
Abdul Al-Farsi, *Ayman Al-Talib

A 42-YEAR-OLD WOMAN PRESENTED WITH abdominal pain, increasing hirsutism and clitoromegaly [Figure 1]. Her plasma testo-

sterone levels were very high (total testosterone: 33.3 
ng/mL, free testosterone: 912 pg/mL) and the canver 
antigen 125 (CA-125) test was 120 U/mL. The com-
puted tomography showed a large, 12.7 x 7.2 cm, lobu-
lated, enhancing mass with central necrosis originat-
ing from the right ovary with a moderate amount of 
ascites. The preoperative diagnosis was Sertoli-Leydig
cell tumor. The patient had an exploratory laparato-
my where a total hysterectomy, bilateral salpingo-
oopherectomy, lymph nodes dissection and omentec-
tomy were performed [Figure 2].  The tumour, which
was removed, was confined to the right ovary and
there was no evidence of adjacent structures involve-
ment. No ascites was seen. During the surgery, the 
patient’s blood pressure went up to 240/140 mmHg. 
Postoperatively, the patient was doing well though her 
blood pressure was uncontrolled so was started on 

الستيرويدية اخللية ورم

الطالب أمين  عبدول الفارسي،

I N T E R E S T I N G  M E D I C A L  I M A G E

Department of Obstetrics and Gynaecology, McGill University, Montreal, Canada

*To whom correspondence should be addressed. Email: ayman.altalib@gmail.com

Figure 1: Clitoromegaly Figure 2: Steriod cell tumor gross appearance

Figure 3: Histological appearance of   cell tumor



359

S T E R O I D  C E L L  TU M O R

Micardis® (telmisartan). Serum levels of testosterone 
returned to normal a few weeks after the surgery. The
histopathological diagnosis was a steroid cell tumor, 
not otherwise specified [Figure 3].

Steroid cell tumours of the ovary account for ap-
proximately 0.1% of all ovarian tumours and are sub-
divided into 3 subtypes: stromal leuteomas, Leydig 
cell tumours, and steroid cell tumours, not otherwise 
specified (NOS). The steroid cell tumour (NOS) is the
most common of the 3 subtypes, accounting for ap-
proximately 60% of these tumors and the majority of 
them show virilisation,1, 2  25-45% of which are clinical-
ly malignant.2, 3 Estrogen secretion occurs in 6% to 23% 
of the tumors, which may be associated with menor-
rhagia, postmenopausal bleeding, or even endometrial 
adenocarcinoma. Cushing’s syndrome occurs in 6% to 
10% of the cases. Approximately 25% of the cases of 
steroid cell tumours (NOS) are not associated with 
hormonal disturbances.4 They can occur at any age,
but usually develop in adults with an average age of 43 
years. 1 Steroid cell tumours often present as unilat-
eral solid tumours and occasionally as cystic tumours. 
Necrosis or calcification is frequently associated. 5 
Ovarian steroid cell tumours are characterised by cells 
with abundant intracellular lipids, which are similar 
to adrenocortical cells. 6 The classical gross finding of
steroid cell tumor (NOS) is a solid, well-circumscribed 
ovarian mass. Microscopic findings include diffusely
arranged cells, although tumor cells may be present in 
nests, clusters, cords, or columns. The stroma is most
commonly scant, but may be prominent and can oc-

casionally be fibromatous, edematous, or myxoid. The
cells are polygonal to round, with distinct cell borders 
and central nuclei, and they often have prominent nu-
cleoli. The cytoplasm varies from spongy in lipid-rich
cells to granular and eosinophilic in lipid-poor or li-
pid-free cells [Figure 3]. The mainstay of ovarian ster-
oid cell tumor is surgery. Careful follow-up evaluation 
should include a measurement of sex hormone levels, 
particularly for those patients who demonstrated el-
evated levels before removal of the primary tumor.

R E F E R E N C E S

1.  Kim YT, Kim SW, Yoon BS, Kim SH, Kim JH, Kim JW, et 
al. An ovarian steroid cell tumor causing virilization and 
massive ascites. Yonsei Med J. 2007; 48:142-146.

2. Veras E, Deavers MT, Silva EG, Malpica A. Ovarian 
steroid cell tumor, not otherwise specified: a clinico-
pathologic study. Zhonghua Bing Li Xue Za Zhi 2007; 
36:516-520.

3.  Liu AX, Sun J, Shao WQ, Jin HM, Song WQ. Steroid cell 
tumors, not otherwise specified (NOS), in an accessory
ovary: a case report and literature review. Gynecol On-
col 2005; 97:260-262.

4.  Malaika W, Sathima Natarajan. Pathologic Quiz Case: 
A Rare Tumor of the Ovary. Arch Pathol Lab Med 2003; 
127:890–892.

5.  Faraj G, Di Gregorio S, Misiunas A, Faure EN, Villabrile 
P, Stringa I, et al. Virilizing ovarian tumor of cell tumor 
type not otherwise specified: a case report. Gynecol En-
docrinol 1998; 12:347-352.

6.  Hayes MC, Scully RE. Ovarian steroid cell tumors (not 
otherwise specified). A clinicopathological analysis of
63 cases. Am J Surg Pathol. 1987; 11:835-845.