Silent Ovary with a Loud Hormonal Signal: A Case Report and Literature Review of an Androgen-Secreting Stromal Luteoma

Background: Less than 0.1% of ovarian cancers are ovarian steroid cell tumors, which are very uncommon sex cord-stromal neoplasms. A rare and usually benign form, stromal luteomas primarily affect postmenopausal women. These tumors can have major hormonal consequences despite their small size. The most common symptom is estrogen excess; androgen release with virilization is uncommon and might be challenging to spot, especially when imaging is subtle. Case Presentation: A 57-year-old postmenopausal woman presented with a three-year history of escalating hyperandrogenism, which included clitoromegaly, frontotemporal hair thinning, deeper voice, and quickly deteriorating hirsutism. Laboratory analyses revealed significantly elevated serum testosterone levels, reaching the male reference range, accompanied by reduced gonadotropins. Androstenedione and DHEAS levels were within normal ranges. Cushing’s syndrome and congenital adrenal hyperplasia were excluded. Although transvaginal color Doppler ultrasonography revealed asymmetric ovarian enlargement of the left ovary, initial imaging revealed neither ovarian nor adrenal tumors. The patient underwent a bilateral oophorectomy performed laparoscopically. A 1.5-cm steroid cell tumor of the left ovary, compatible with stromal luteoma, was verified by histopathology and immunohistochemistry. Following surgery, testosterone levels rapidly returned to normal, while virilizing features gradually regressed. Conclusions: This example highlights how, even in cases when initial imaging is unremarkable, postmenopausal women with rapid virilization and noticeably higher testosterone levels should be evaluated for rare androgen-secreting ovarian tumors. A timely diagnosis requires a complete assessment of ovarian morphology and a thorough endocrine evaluation. Both biochemical abnormalities and clinical signs can be resolved with surgical excision, which offers a definitive treatment.