PMC3514067_01
Resected specimen. (A) Macroscopic findings. The tumor was an orange-colored solid mass. (B) Microscopic findings.. Note: The tumor cells contained small round nuclei and abundant translucent cytoplasm, and were arranged in nested and cord-like patterns.
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Macroscopically, the tumor was an orange-colored solid mass, which caused partial rupture of the ovarian capsule (Figure 1A). Microscopically, the tumor cells contained small round nuclei and abundant vacuolated cytoplasm, and were arranged in nested and cord-like patterns (Figure 1B).
Postoperative changes in androgen levels.. Notes: After surgery, the patient's total testosterone level returned to normal, but free testosterone and dehydroepiandrosterone sulfate levels remained above the normal range. Following pioglitazone administration and weight reduction, androgen levels returned to normal.
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After the operation, menstruation occurred spontaneously but remained irregular, and although the patient's serum androgen levels declined, they remained above normal (Figure 2).
Effects of various treatment modalities on hormonal and biochemical parameters.. Notes: After surgery, total testosterone levels returned to normal, but free testosterone levels remained above normal. Weight loss successfully resolved the patient's insulin resistance and hyperandrogenemia.. Abbreviations: F-T, free-testosterone; FPG, fasting plasma glucose; IRI, immunoreactive insulin; HOMA-IR, homeostasis model assessment of insulin resistance; Adipo, adiponectin.
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Two years of pioglitazone treatment at 15 mg/day was effective, but did not completely resolve her refractory hirsutism, insulin resistance, or free testosterone level (Figure 3). Loss of 12 kg of body weight (to 53 kg, body mass index 21.2 kg/m2) completely corrected both her hyperandrogenism and insulin resistance (Figure 3).