A Malignant Androgen-Secreting Ovarian Tumour Misdiagnosed as Polycystic Ovary Syndrome: A Case Report

Abstract

Background: Hyperandrogenism in women most commonly arises from polycystic ovary syndrome (PCOS). However, rare androgen-secreting ovarian tumours may present with overlapping symptoms, posing a diagnostic challenge and contributing to delayed diagnosis.

Methods: A 35-year-old woman presented with a 5-month history of irregular menses, initially managed as PCOS without improvement. Evaluation included history, examination, hormone assays, pelvic ultrasound, MRI and histopathology.

Results: Examination revealed virilization including frontal balding, severe hirsutism, voice deepening, and clitoromegaly. Laboratory results showed significantly elevated total testosterone of 257 ng/dL (ref 15–70 ng/dL) and free testosterone of  3.2 ng/dL (ref 0.1–1.9 ng/dL) with elevated androstenedione of 3.7 ng/dL (ref 0.3-3.3 ng/mL)  but normal DHEAS,FSH,LH and 17-OHP. Pelvic ultrasound/MRI identified a 2×4 cm right ovarian mass. A biopsy was taken confirming malignancy and histopathology assessment confirmed it was an androgen-secreting ovarian steroid cell tumour.

Conclusion: Progressive virilization and significantly elevated testosterone in presumed PCOS should raise suspicion for alternative aetiologies including androgen-secreting ovarian tumours which are rare but are clinically significant due to their potential malignancy.