USMLE Question No.4: A 57-year-old woman had her last menstrual period at the age of 46 ....

A 57-year-old woman had her last menstrual period at the age of 46. However, for the past 4 months she has experienced intermittent vaginal hemorrhage. A right ovarian mass is identified.Which of the following is the most likely diagnosis?

(A) arrhenoblastoma
(B) Brenner tumor
(C) dysgerminoma
(D) granulosa cell tumor
(E) Sertoli-Leydig cell tumor
(F) teratoma

Answer:
D:

An ovarian mass raises the possibility of a tumor and vaginal hemorrhage in a postmenopausal woman and suggests an estrogenproducing tumor. One of the first estrogenproducing tumors to consider is granulosa cell tumor. Arrhenoblastoma (Sertoli-Leydig cell tumor) (choice A) secretes androgens, not estrogens. Brenner tumor (choice B) is an uncommon ovarian neoplasm without hormonal activity. Dysgerminoma (choice C) is the female counterpart of the male seminoma and does not produce hormones. Sertoli-Leydig cell tumor (choice E) is a synonym for arrhenoblastoma (choice A). Teratoma (choice F) is also hormonally inactive.