Jo ur nal o f Ca se s in Ob st et ri cs &G yn ec olog y J Cases Obstet Gynecol, 2016;3(1):19-21 Case Report A rare case of postmenopausal severe virilization: Ovarian steroid cell tumor, not otherwise specifed Gulseren Dinc 1 , Ismail Saygin 2 , Cavit Kart 3 , Sevdegul Mungan 2 , Suleyman Guven 3,* , E. Seda Guvendag Guven 3 1 Medical Park Hospital, Obstetrics and Gynecology Clinic, Trabzon, Turkey 2 Karadeniz Technical University, School of Medicine, Dept. of Pathology, Trabzon, Turkey 3 Karadeniz Technical University, School of Medicine, Depts. of Obstetrics and Gynecology, Trabzon, Turkey Abstract The very small fraction (0.1%) of ovarian sex cord-stromal tumors are known as ovarian steroid cell tumors, not otherwise specifed (OSCT- NOS). Such tumors have also classifed in ovarian malign tumors. The known famous features of these rare tumors are the small size and hor- mone secretion. High levels of androgen secretion may cause hirsutism, hyperandrogenism symptoms and even virilization in woman. A 51-years-old postmenopozal multiparous woman was referred to our hospital with the complaint of severe virilisation and for further evalu- ation of high serum testosterone levels. Transvaginal sonography and MRI revealed slightly enlarged right ovary. Surgical removal of uter- us and ovary was carried out. Histopathology showed a 1.5 cm occult OSCT-NOSin the stroma of the right ovary.The clinicians should keep in mind the possible diagnosis occult OSCTin case of high serum androgen levels and in the presence of severe virilization symptoms. Key words: Sex-cord stromal tumor, virilization, ovarian cancer, androgen. Introduction The very small fraction (0.1%) of ovarian sex cord-stro- mal tumors are known as ovarian steroid cell tumors, not otherwise specifed (OSCT-NOS). Such tumors have also classifed in ovarian malign tumors. The known famous fea- tures of these rare tumors are the small size and hormone secretion (progesterone, estrogen, androgen, adrenal cortical hormones, or adrenocorticotropic hormone). High levels of androgen secretion may cause hirsutism, hyperandrogenism symptoms and even virilization in woman. The small tumor size may make diffcult to visualize the tumor preoperative- ly with imaging modalities[1]. The aim of this case report is to report a case of occult OSCT-NOSpresenting with the complaint of severe virilization in a postmenopozal woman. Journal of Cases in Obstetrics & Gynecology 19 Article history: Received: 01/07/2015 Accepted: 11/11/2015 * Correspondence: Suleyman GUVEN, MD Address: Karadeniz Technical University, School of Medicine, Dept of Obstetrics and Gynecology, 61080, Trabzon, Türkiye. Tel : +90 462 377 5869 E-mail : drsuleymanguven@yahoo.com Case presentation A 51-years-old postmenoposalmultiparous lady was re- ferred to our hospital with the complain of severe virilisa- tion and further evaluation of high serum testosterone levels. She had the history of progressive hirsutism for 8 years. Her medical history was unremarkable except hypertension for four years. She has been in menopause since 40 years of age. Physical and pelvic examination revealed virilization signs (high modifed Ferriman Gallwey score (34 point), high clitorial index value, male pattern of the voice). Pelvic examination did not reveal any other ovarian and uterine pathology. Initial hormonal evaluation results are given in Table 1. Normal serum levels of ovarian tumor markers were reported. Sonographic scan of uterus, ad- renal gland and other abdominal organs has not revealed signifcant fndings. The ovary volumes were 4cc for the right ovary and 3.5 cc for left ovary. Magnetic reso- nance imaging (MRI) and computed tomography (CT) has also confrmed a slightly large right ovary and nor- mal intraabdominal organs. These fndings gave the idea