A Patient With Diabetes and Breast Cancer In Whom Virilization Was Caused by a Testosterone-Producing Mature Cystic Teratoma Containing a Brenner Tumor

A 74-year-old woman with impaired glucose tolerance exhibited virilization. An examination of various hormone levels showed normal pituitary hormone and adrenal hormone levels. However, the patient's blood testosterone level was remarkably high and was suspected of having caused the virilization. An abdominal computed tomography revealed a multilocular cystoma in the left ovary with the features of a mature cystic teratoma. In addition, a chest computed tomography revealed the presence of a mass in the left breast that was subsequently diagnosed as breast cancer based on the results of a biopsy. After the simultaneous surgical resection of the ovarian and breast tumors, her blood testosterone level decreased. The mature cystic teratoma containing a Brenner tumor was considered to be responsible for the high testosterone level because of the presence of androgenic enzymes. This case is extremely rare, but the case was accurately diagnosed through a comprehensive analysis.

[1]  Michael R. Kennedy,et al.  Type 5 17beta-hydroxysteroid dehydrogenase (AKR1C3) contributes to testosterone production in the adrenal reticularis. , 2009, The Journal of clinical endocrinology and metabolism.

[2]  J. Adamski,et al.  Integrated view on 17beta-hydroxysteroid dehydrogenases , 2009, Molecular and Cellular Endocrinology.

[3]  F. Berrino,et al.  Sex Hormone Levels, Breast Cancer Risk, and Cancer Receptor Status in Postmenopausal Women: the ORDET Cohort , 2009, Cancer Epidemiology Biomarkers & Prevention.

[4]  D. Wu,et al.  Postmenopausal hyperandrogenism caused by a benign cystic teratoma: a case report. , 2008, The Journal of reproductive medicine.

[5]  S. Hankinson,et al.  Endogenous estrogen, testosterone and progesterone levels in relation to breast cancer risk , 2007, The Journal of Steroid Biochemistry and Molecular Biology.

[6]  R. Hoover,et al.  Serum concentrations of estrogens, sex hormone‐binding globulin, and androgens and risk of breast cancer in postmenopausal women , 2006, International journal of cancer.

[7]  G. Colditz,et al.  Combined estrogen and testosterone use and risk of breast cancer in postmenopausal women. , 2006, Archives of internal medicine.

[8]  R. Rosenfield Clinical practice. Hirsutism. , 2005, The New England journal of medicine.

[9]  D. Edwards,et al.  The validation of new aromatase monoclonal antibodies for immunohistochemistry—A correlation with biochemical activities in 46 cases of breast cancer , 2005, The Journal of Steroid Biochemistry and Molecular Biology.

[10]  R. Rosenfield,et al.  Characterization of the basal promoter element of the human type 5 17beta-hydroxysteroid dehydrogenase gene. , 2005, Biochimica et biophysica acta.

[11]  S. Hankinson,et al.  Endogenous estrogen, androgen, and progesterone concentrations and breast cancer risk among postmenopausal women. , 2004, Journal of the National Cancer Institute.

[12]  Wolfgang Eiermann,et al.  An overview of the pharmacology and pharmacokinetics of the newer generation aromatase inhibitors anastrozole, letrozole, and exemestane , 2002, Cancer.

[13]  T. Key,et al.  Endogenous sex hormones and breast cancer in postmenopausal women: reanalysis of nine prospective studies. , 2002, Journal of the National Cancer Institute.

[14]  M. Vantyghem,et al.  Virilizing ovarian dermoid cyst with peripheral steroid cells. A case study with immunohistochemical study of steroidogenesis. , 1999, International journal of gynecological pathology : official journal of the International Society of Gynecological Pathologists.

[15]  S. Cummings,et al.  Elevated Serum Estradiol and Testosterone Concentrations Are Associated with a High Risk for Breast Cancer , 1999, Annals of Internal Medicine.

[16]  T. Key,et al.  Prevalence of the polycystic ovary syndrome in unselected black and white women of the southeastern United States: a prospective study. , 1998, The Journal of clinical endocrinology and metabolism.

[17]  M. Muñoz-Torres,et al.  Virilizing mature ovarian cystic teratomas , 1997, Virchows Archiv.

[18]  M. Tomlinson,et al.  Testosterone-producing benign cystic teratoma with virilism. A case report. , 1996, The Journal of reproductive medicine.

[19]  K. Kaga,et al.  Adrenal 4-binding protein in common epithelial and metastatic tumors of the ovary. , 1996, Human pathology.

[20]  J. H. Eichhorn,et al.  Case 24-1993 , 1993 .

[21]  Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 24-1993. A 56-year-old woman with virilization. , 1993, The New England journal of medicine.

[22]  M. Vecsernyés,et al.  Low-dose aminoglutethimide therapy without glucocorticoid administration. Clinical and hormonal findings. , 1992, Oncology.

[23]  H. Sasano,et al.  Immunolocalization of 3β-hydroxysteroid dehydrogenase in human ovary , 1990 .

[24]  J. Calaf,et al.  [A 56-year-old woman with virilization]. , 1987, Medicina clinica.

[25]  M. Kim,et al.  Hirsutism: implications, etiology, and management. , 1981, American journal of obstetrics and gynecology.

[26]  F. Vellios,et al.  The Origin of Androgen and Estrogen in a Virilized Postmenopausal Woman With Bilateral Benign Cystic Teratomas , 1977, Obstetrics and gynecology.