EP30.20: Ovarian hyperthecosis: ultrasound findings

Patient was a 47-year-old, Indian, nulliparous. She presented with intermenstrual bleeding with abdominal pain. Her medical history included diabetes mellitus, hyperlipidemia, ischemic heart disease and hypertension. Ultrasound scan which was performed noted a 3.3 x 1.9 x 2.2 cm heterogeneous area in the right ovary. Minimal intratumoral flow was noted. Left ovary was not visualised. Uterus demonstrated normal ultrasound features, endometrium was 3 mm. Patient was offered D&C (Dilation and Curettage) hysteroscopy, KIV (keep in view) removal of fibroma. Patient preferred to consider and declined endometroid sampling. She was reviewed again after two months. She was still having intermenstrual bleeding with abdominal pain. A pelvic ultrasound was performed and noted endometrium to be 6.5 mm; right ovary was enlarged with a 3.4 x 2.1 x 2.0 cm heterogeneously hypoechoic mass; colour Doppler noted minimal intratumoral perfusion. Impression: mass was probably ovarian fibroma. Left ovary was not identified. Patient consented to laparoscopic right oophorectomy, hysteroscopy D&C. Intraoperative findings: Vulva, vagina and cervix were normal. Uterus was 6 weeks size, anteverted, uterine cavity length was 8cm and presenting normal features, no polyp was identified; no abnormality was noted in endometrium, bilateral ostia were identified; endocervical canal was normal; Left ovary was atrophic and miniscule; Right ovary was enlarged to 3x5cm, unable to delineate fibroma versus normal ovarian tissue. Liver was noted as normal. Histology: Endometrial curetting: mid-secretory endometrium. Right ovary: consistent with stromal hyperplasia and stromal hyperthecosis. Hyperthecosis was noted in the atrophic left ovary as well. In conclusion, ovarian hyperthecosis may mimic ovarian mass and presented difficulty in diagnosis.