When abundant, these can stand out sharply but they are often ill defined and rarely are they the robust luteinized cells of entities such as stromal hyperthecosis
or as seen in the stroma of diverse neoplasms.
Later on, bilateral laparoscopic salpingo-oophorectomy and excisional biopsy revealed left stromal luteoma, bilateral stromal hyperthecosis
and right paratubular cysts.
Differential diagnosis includes granulosa cell tumor, thecomas, stromal hyperthecosis
, unclassified sex cord- stromal tumors, stromal luteomas and hyperreactio luteinalis (8).
Leydig cell tumor, non hilar type, is composed of steroid cells containing Reinke crystals and surrounded by ovarian stroma that often shows stromal hyperthecosis
, and except for their location, the clinical and pathological features of the non hilar type is similar to that of the hilar type.
DISCUSSION: Ovarian hyperthecosis or stromal hyperthecosis
with HAIR--AN Syndrome is a rare disorder clinically similar to PCOS but with greater intensity of androgenisation and is associated with insulin resistance and type 2 diabetes.