RESUMEN
Postmenopausal hyperandrogenism constitutes a very rare condition of tumoral or non-tumoral origin primarily residing either in the ovary or in the adrenal glands. We present herein two cases with this condition; one with abnormal postmenopausal genital bleeding and mild increase in facial hair, and the second with slow-developing hirsutism and virilization. Both cases shared a notorious increase in libido. The laboratory tests showed high levels of testosterone (>100 ng/ml). A normal value of dehydroepiandrosterone sulfate and a normal cortisol level at 9 am after 1 mg of dexamethasone administered at midnight (Nugent test) made an adrenal etiology very unlikely. On the other hand, a high level of inhibine B oriented to an ovarian source. Transvaginal sonography failed to demonstrate an ovarian tumor, but an abdominal and pelvic computed tomography scan or magnetic resonance imaging detected an ovarian tumor and normal adrenal glands. A laparoscopic oophorectomy was performed, and the histological study demonstrated a steroidal cell tumor in the first case and a Leydig cell tumor in the second.
Asunto(s)
Andrógenos/metabolismo , Hiperandrogenismo , Tumor de Células de Leydig/diagnóstico , Neoplasias Ováricas/diagnóstico , Posmenopausia , Anciano , Diagnóstico Diferencial , Femenino , Humanos , Tumor de Células de Leydig/diagnóstico por imagen , Tumor de Células de Leydig/metabolismo , Tumor de Células de Leydig/patología , Imagen por Resonancia Magnética , Persona de Mediana Edad , Neoplasias Ováricas/diagnóstico por imagen , Neoplasias Ováricas/metabolismo , Neoplasias Ováricas/patología , Ovariectomía , Tomografía Computarizada por Rayos XRESUMEN
OBJECTIVES: Ultrasound (US) is often used for the work-up of testicular pathology. The findings may implicate on its management. However, there is only scant data on the correlation between US findings and testicular tumor type and size. Herein, we report on a multicenter study, analyzing these correlations. METHODS: The study included patients who underwent orchiectomy between 2000 and 2010. Their charts were reviewed for US echogeneity, lesion size, pathological dimensions, histology, and the presence of calcifications, fibrosis, necrosis and/or intraepithelial neoplasia. The incidence of these parameters in benign versus malignant lesions and seminomatous germ cell tumors (SGCT) versus nonseminomatous germ cell tumors (NSGCT) was statistically compared. RESULTS: Eighty five patients fulfilled the inclusion criteria, 71 malignant (43 SGCT, 28 NSGCT) and 14 benign. Sonographic lesions were at least 20% smaller than the pathologically determined dimensions in 21 (25%) patients. The ability of US in estimating the size of malignant tumors was 71%, compared to 100% of benign tumors (p=0.03), with no significant difference between SGCT and NSGCT. Necrosis was more frequent in malignant tumors (p=0.03); hypoechogeneity and fibrosis were more frequent in SGCT than in NSGCT (p=0.002 and 0.04 respectively). CONCLUSIONS: Testis US of malignant lesions underestimates the size in 25% of the cases, a fact that may impact on the decision of testicular sparing surgery. The ultrasonic lesions were eventually proven to be benign in 16% of the cases. Therefore it is advised to apply frozen sections in borderline cases. Hypoechogeneity is more frequent in SGCT than NSGCT.
Asunto(s)
Orquiectomía/estadística & datos numéricos , Seminoma/diagnóstico por imagen , Neoplasias Testiculares/diagnóstico por imagen , Testículo/diagnóstico por imagen , Carga Tumoral , Fibrosis , Secciones por Congelación , Humanos , Tumor de Células de Leydig/diagnóstico por imagen , Tumor de Células de Leydig/patología , Masculino , Necrosis , Tamaño de los Órganos , Valor Predictivo de las Pruebas , Estudios Retrospectivos , Seminoma/patología , Neoplasias Testiculares/patología , Testículo/patología , UltrasonografíaRESUMEN
Presentamos un nuevo caso de un tumor de células de Leydig del adulto, tratado en el servicio de urología de Antártida Hospital Privado en el año 1996, su diagnóstico y seguimiento. Es preciso destacar la baja incidencia de esta patología dentro de los tumores testiculares (1-3 por ciento). Algunos de los parámetros humorales e histológicos pueden hacer sospechar un comportamiento agresivo. Un 10 por ciento de ellos evoluciona dfando metástasi a distancia. La ginecomastia se suele observar en un 30 por ciento de los adultos. El tratamiento es la orquifuniculectomía, siendo resistentes a la radioterapia y muy poco sensibles a la quimioterapia(AU)