Leydig cell tumours originate from ovarian sex cord stroma and compromise less than 0.1% of all ovarian tumours. Their unregulated testosterone secretion results in hyperandrogenism and virilization.

A 62year old postmenopausal Para 2 patient presented at Father Muller medical college hospital Mangalore with rapidly progressive hirsutism and alopecia since 1 year. Physical examination revealed high grade hirsutism and Internal examination revealed bulky uterus and a 4 x 4 cm right adnexal mass. Pelvic ultrasonography revealed 3.3 x 3.5centimetres right adnexal solid lesion, which was confirmed on MRI. Blood investigations revealed high serum testosterone with normal DHEA-S and serum cortisol. Low dose dexamethasone suppression test confirmed ovary to be the source of elevated testosterone. She underwent stagging laparotomy with frozen section. Frozen section revealed features of benign sex cord stromal tumours. Final histopathological examination revealed pure Leydig cell tumour with Reinke crystals without infiltrated blood vessels or nerves.

While investigating a case of postmenopausal hyperandrogenism, ovarian cancers and adrenal cancers should be considered. The final diagnosis is by histopathological evaluation of the tumour which is considered as the gold standard. These postmenopausal virilizing ovarian tumours are most often benign but they require surgery which is the main stay of treatment to control the symptoms. In those patients who have an advanced disease or have recurrence, it is recommended that adjuvant chemotherapy be given.