{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:53:17Z","timestamp":1791219197543,"version":"4.1.0"},"reference-count":16,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T00:00:00Z","timestamp":1791158400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["82272004"],"award-info":[{"award-number":["82272004"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["82272004"],"award-info":[{"award-number":["82272004"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004731","name":"Zhejiang Provincial Natural Science Foundation","doi-asserted-by":"publisher","award":["LZ22H180001"],"award-info":[{"award-number":["LZ22H180001"]}],"id":[{"id":"10.13039\/501100004731","id-type":"DOI","asserted-by":"publisher"}]},{"award":["LZ22H180001"],"award-info":[{"award-number":["LZ22H180001"]}],"id":[{"id":"https:\/\/ror.org\/04aqat463","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: The current WHO classification recognizes gonadoblastoma and mixed germ cell\u2013sex cord-stromal tumor, unclassified, as distinct ovarian germ cell\u2013sex cord-stromal tumors. Their heterogeneous components may generate discordant endocrine, biochemical, and imaging findings. Case Presentation: An 18-year-old nulliparous woman with a 46,XX peripheral blood karyotype presented with progressive virilization and an enlarging left ovarian mass. Preoperative total testosterone was &gt;16,000 pg\/mL and \u03b2-human chorionic gonadotropin (\u03b2-hCG) was 192.0 IU\/L. Magnetic resonance imaging (MRI) and transrectal contrast-enhanced ultrasound (CEUS) favored an androgen-producing sex cord-stromal tumor; CEUS showed heterogeneous hyperperfusion with mildly disorganized intratumoral vessels. Computed tomography (CT) suggested a mixed germ cell tumor, and frozen section favored a steroid cell tumor while not excluding a focal germ-cell component. Fertility-sparing surgery was performed. Final pathology showed dissecting gonadoblastoma with dysgerminoma transformation and trophoblastic differentiation, combined with a Leydig cell tumor. Serum \u03b2-hCG fell to 80.4 IU\/L on postoperative day 1 and to &lt;0.2 IU\/L by January 2026, accompanied by androgen normalization and resumption of menstruation. At 6.5 months, the patient remained clinically well; ultrasound showed a normal right ovary and no evident left adnexal mass, although contemporaneous endocrine and tumor-marker measurements were unavailable. Conclusions: In a heterogeneous ovarian tumor, the dominant phenotype may represent only one component. Discordance among endocrine findings, tumor markers, and imaging should prompt consideration of mixed histology. \u03b2-hCG elevation in an androgen-secreting ovarian tumor may indicate an occult germ-cell or trophoblastic component, whereas CEUS should be interpreted as a vascular phenotype rather than a histology-specific signature.<\/jats:p>","DOI":"10.3390\/diagnostics16193223","type":"journal-article","created":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:51:29Z","timestamp":1791215489000},"page":"3223","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic Discordance in a 46,XX Ovarian Dissecting Gonadoblastoma with Dysgerminoma Transformation and Leydig Cell Tumor: Hyperandrogenism, \u03b2-hCG Elevation, and CEUS Findings"],"prefix":"10.3390","volume":"16","author":[{"given":"Jiahui","family":"Yu","sequence":"first","affiliation":[{"name":"Department of Ultrasound, Women\u2019s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China"},{"name":"Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women\u2019s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiang","family":"Zhu","sequence":"additional","affiliation":[{"name":"Department of Ultrasound, Women\u2019s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China"},{"name":"Zhejiang Provincial Key Laboratory of Precision Diagnosis and Therapy for Major Gynecological Diseases, Women\u2019s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"ref_1","unstructured":"WHO Classification of Tumours Editorial Board (2020). 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