The Use of Ovarian Vein Sampling to Lateralize a Virilizing Leydig Cell Ovarian Tumor

This case report highlights the effectiveness of ovarian vein sampling (OVS) and adrenal vein sampling (AVS) in diagnosing a virilizing Leydig cell ovarian tumor in a 56-year-old postmenopausal woman, where imaging was inconclusive. The patient's elevated testosterone levels and a left-to-right ovarian testosterone ratio of 41.94 indicated a left-sided tumor, which was confirmed as a 1.0 cm Leydig cell tumor in the left ovary after a bilateral salpingo-oophorectomy. Post-surgery, her testosterone levels normalized, and her symptoms improved. The study supports using a left-to-right ovarian vein testosterone ratio of ≥15 for tumor lateralization and suggests that more cases could help establish guidelines for interpreting OVS results.