A virilising ovarian tumor case study done by Dr. Sabyasachi Parida
A young female in her teens presented with longstanding complaints of menstrual irregularities, excessive acne on her face and body, excessive facial and body hair which was not present since childhood. She had consulted several gynaecologists till she was advised to see an endocrinologist. He immediately diagnosed that there was excess production of male hormones in her body leading to above features. On imaging she was found to have a solid tumor in one of her ovaries with another cystic lesion in her opposite ovary. She was referred to Dr. Sabyasachi Parida, Consultant Oncosurgeon, for further management.
Although she was found to have small ovarian lesions, such symptomatology could also have arisen from the adrenal glands, which are small glands that lie over each kidney at its upper pole. The other issue was, which ovary was responsible or both had disease, as the tumor can sometimes be bilateral. More importantly preservation of ovarian function was important as she was a young girl with a long life ahead.
These issues were discussed in detail with the patient and her parents and surgery was planned.
Pelvic cavity was entered by a sub-umbilical incision to enable the scar to be concealed. Intraoperative sampling was done from each ovarian vein to assess which ovary was producing male hormone. Lab reports were received within one hour from in-house laboratory which pointed to one ovary as the source. This technique and synergy with available facility is unique to the surgeon and institution where the surgeon operates.
Tumor was completely excised while normal ovarian substance and function were safeguarded. Contralateral ovarian cyst was also removed. Both samples were sent for Frozen Section analysis, which is a technique of arriving at a pathological diagnosis on quickly frozen tissue. Reports are usually available within one hour. Reports came in as a benign ovarian tumor on one side and normal ovarian cysts on the other side. Histopathology reports confirmed the findings on frozen section. She has been on follow up for more than a year now, cured of her disease, without any recurrence . She is just like any other normal girl of her age and is doing well. We wish her all the best in life.