Publication:

Androgen-secreting borderline mucinous ovarian tumor in pregnancy: multidisciplinary management of gestational hyperandrogenism

Most adnexal masses diagnosed during pregnancy are benign, but a subset is malignant, borderline, or hormonally active. Androgen-secreting tumors are particularly rare and carry an added risk of fetal virilization. We report the case of a 38-year-old pregnant woman incidentally diagnosed with a complex adnexal mass at 13 weeks of gestation, which showed progressive growth and was associated with elevated androgen levels suggestive of a functional tumor. A multidisciplinary team initiated conservative management with spironolactone to reduce the risk of fetal virilization, and surgery was performed at 28 weeks due to tumor growth progression. Histopathology confirmed a borderline mucinous tumor with Leydig cell hyperplasia. The patient had an uneventful recovery, with normalization of testosterone levels and a term delivery of a healthy newborn with no signs of virilization. This case, compared with the only three previously reported cases of this tumor in pregnancy, illustrates that an individualized, multidisciplinary approach to gestational hyperandrogenism caused by adnexal masses, combining conservative management with timely surgical intervention when indicated, can achieve favorable maternal and fetal outcomes.