{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,21]],"date-time":"2026-02-21T06:10:23Z","timestamp":1771654223146,"version":"3.50.1"},"reference-count":14,"publisher":"Wiley","issue":"10","license":[{"start":{"date-parts":[[2023,10,18]],"date-time":"2023-10-18T00:00:00Z","timestamp":1697587200000},"content-version":"vor","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Ovarian steroid cell tumors are a rare subtype of sex\u2010cord stromal cell tumors. Overall, these tumors make &lt;0.1% of all ovarian tumors. These neoplasms can be divided according to the cell of origin into stromal luteomas, Leydig cell tumors, and steroid cell tumors not otherwise specified. These tumors can be benign, malignant, or borderline, with variable presentation. We report a case of 24\u2010year\u2010old virgin female who was referred to our hospital after being diagnosed with steroid cell tumor\u2010not otherwise specified. Prior to her admission, the patient had been treated unsuccessfully with oral contraceptive pills due to male\u2010pattern facial hair growth, abdominal cramps, and irregular menstrual cycle. Lack of improvement warranted further investigations. Hormonal studies showed an elevated total testosterone, dehydroepiandrosterone sulfate, and morning fasting cortisol. Ultrasonography and computed tomography confirmed the presence of a large pelvic mass with mixed solid and cystic component. Therefore, unilateral salpingo\u2010oophorectomy was performed. Pathological and immunohistochemical examination suggested the presence of a large ovarian steroid cell tumor\u2010not otherwise specified with malignant behavior. The patient did not receive adjuvant therapy and developed metastatic disease. She received four cycles of BEP protocol with no improvement, so she was referred to our center to continue oncological management. Case revision confirmed the presence of steroid cell tumor, but of a different subtype: Leydig cell. She received six cycles of carboplatin\u2010paclitaxel, but her assessment showed disease progression. We report this case with review of literature regarding the appropriate approach to these rare tumors. Although rare, ovarian steroid cell tumors should be included in the differential diagnosis of virilization in young females, especially those refractory to hormonal therapy. In our study, we aimed to present the first reported Palestinian case, which highlights the importance of detailed morphological examination in addition to the difficulties encountered to reach a proper diagnosis. We also provided a review of the existing literature regarding chemotherapeutic lines used in such cases and the response to each.<\/jats:p>","DOI":"10.1002\/ccr3.7915","type":"journal-article","created":{"date-parts":[[2023,10,19]],"date-time":"2023-10-19T00:34:45Z","timestamp":1697675685000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Hirsutism as the initial presentation of malignant ovarian Leydig cell tumor: A case report"],"prefix":"10.1002","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6484-5606","authenticated-orcid":false,"given":"Hasan","family":"Arafat","sequence":"first","affiliation":[{"name":"Cancer Care Center Augusta Victoria Hospital  Jerusalem Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marah","family":"Khaldy","sequence":"additional","affiliation":[{"name":"Cancer Care Center Augusta Victoria Hospital  Jerusalem Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmad","family":"Abu\u00a0Munshar","sequence":"additional","affiliation":[{"name":"Cancer Care Center Augusta Victoria Hospital  Jerusalem Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amer","family":"Zughayyer","sequence":"additional","affiliation":[{"name":"Cancer Care Center Augusta Victoria Hospital  Jerusalem Palestine"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,10,18]]},"reference":[{"key":"e_1_2_12_2_1","article-title":"An early diagnosis of an ovarian steroid cell tumor not otherwise specified in a woman","volume":"2019","author":"Alves P","year":"2019","journal-title":"Case Rep Obstet Gynecol"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1080\/09513590.2019.1689551"},{"key":"e_1_2_12_4_1","article-title":"Hyperandrogenism, elevated 17\u2010Hydroxyprogesterone and its urinary metabolites in a young woman with ovarian steroid cell tumor, not otherwise specified: case report and review of the literature","volume":"2019","author":"Wong FCK","year":"2019","journal-title":"Case Rep Endocrinol"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1055\/s-0029-1225351"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.12659\/AJCR.933126"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.3109\/09513590.2010.495432"},{"issue":"10","key":"e_1_2_12_8_1","first-page":"6956","article-title":"Clinicopathologic features of ovarian Sertoli\u2010Leydig cell tumors","volume":"7","author":"Zhang HY","year":"2014","journal-title":"Int J Clin Exp Pathol"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.3390\/metabo12070620"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.11345"},{"issue":"4","key":"e_1_2_12_11_1","first-page":"443","article-title":"A girl with steroid cell ovarian tumor misdiagnosed as non\u2010classical congenital adrenal hyperplasia","volume":"55","author":"Y\u0131lmaz\u2010A\u011flad\u0131o\u011flu S","year":"2013","journal-title":"Turk J Pediatr"},{"key":"e_1_2_12_12_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00776-008-1314-7"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12905-021-01244-1"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0b013e318188373d"},{"issue":"3","key":"e_1_2_12_15_1","first-page":"140","article-title":"Leydig cell ovarian tumor \u2010 clinical case description and literature review","volume":"19","author":"Klimek M","year":"2020","journal-title":"Prz Menopauzalny"}],"container-title":["Clinical Case 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