Incidental finding of ovarian mucinous cystadenoma with stromal Leydig cell hyperplasia during cesarean section: A rare case report

Abstract

Introduction and importance

Mucinous cystadenoma of the ovary is a benign epithelial tumor. Its coexistence with stromal Leydig cell hyperplasia during pregnancy is extremely rare. Hormonal shifts during gestation may contribute to stromal changes, yet the clinical significance of such findings remains unclear.

Case presentation

A 21-year-old gravida 2, para 1 woman at 38 + 4 weeks' gestation underwent elective cesarean section. Intraoperatively, a 7 × 5 cm left ovarian cyst was identified and excised. The contralateral ovary appeared normal. Histopathology confirmed mucinous cystadenoma with stromal Leydig cell hyperplasia. The patient was asymptomatic, with no signs of virilization. No serum androgen testing was performed, and she recovered uneventfully postpartum.

Clinical discussion

Mucinous cystadenomas are common benign ovarian tumors, while stromal Leydig cell hyperplasia is rare and often hormonally active. Their coexistence in a pregnant patient without androgenic symptoms is highly unusual. Human chorionic gonadotropin (hCG), known for its LH-like activity, may stimulate Leydig cell proliferation. The absence of clinical virilization could be attributed to low androgen output or increased sex hormone-binding globulin levels in pregnancy.

Conclusion

This case emphasizes the need for vigilance during cesarean sections, the value of histopathological evaluation in incidental adnexal findings, and raises questions about hormonal influences on rare ovarian stromal pathologies in pregnancy.