Sudwita Sinha

Enigma of postmenopausal virilisation: bilateral Leydig cell tumours as the culprit

A postmenopausal woman in her 50s presented with progressive hirsutism, virilisation and markedly elevated serum testosterone levels (>1500 ng/dL). Routine laboratory, adrenal and imaging evaluations were largely unremarkable except for a small left adnexal mass on MRI. With normal dehydroepiandrosterone sulphate (DHEAS) and cortisol levels, an ovarian source of androgen excess was suspected. The patient underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Histopathology revealed bilateral Leydig cell tumours, an exceptionally rare finding. Postoperatively, serum testosterone normalised, and virilisation regressed significantly. This case highlights the importance of considering androgen-secreting ovarian tumours in postmenopausal women with rapidly progressive virilisation, even when imaging is inconclusive. Bilateral Leydig cell tumours are exceedingly uncommon but should be suspected when severe hyperandrogenism is present. Surgical removal remains the definitive diagnostic and therapeutic approach, ensuring hormonal normalisation and symptom resolution while preventing prolonged morbidity associated with delayed diagnosis.

Deciphering a diagnostic enigma from ovarian malignancy to disseminated peritoneal leiomyomatosis

Disseminated peritoneal leiomyomatosis (DPL) is a rare benign disorder of uncertain aetiology that often mimics advanced ovarian or peritoneal malignancy, both clinically and radiologically. The majority of reported cases have been associated with prior laparoscopic uterine myomectomy, particularly when uncontained morcellation was used. Here, we present a case of a nulliparous woman in her 20s who presented with a large abdominopelvic mass and radiological findings suggestive of ovarian carcinoma. However, further history-taking revealed a laparoscopic myomectomy with morcellation performed 2 years earlier for primary infertility due to a large intramural fibroid. Subsequent ultrasound-guided biopsy and immunohistochemistry confirmed the diagnosis of disseminated peritoneal leiomyomatosis (DPL). The objective of this case report is to highlight the diagnostic challenge DPL poses by mimicking malignancy and to emphasise the importance of eliciting prior surgical history—particularly involving morcellation—as a crucial clue in correctly identifying this benign entity.

Giant vulvar acrochordon (skin tag) presenting in second trimester of pregnancy

Fibroepithelial polyps (FEPs), or skin tags or acrochordons, are benign, hormone-responsive lesions commonly found on mucosal and cutaneous surfaces of females of reproductive age. However, it is not very widely reported during pregnancy, with only four cases of vulvar FEP reported in the literature to date in pregnant females. Herein, we present a case of giant FEP of the vulva measuring 10 cm × 10 cm in the second trimester of pregnancy. The lesion was successfully excised without any complications, and histopathological examination confirmed its benign nature.