Pelvic ultrasound scanning in asymptomatic adult-type granulosa cell tumor: A case report and review

Background: Ovarian cancer is common amongst women worldwide. In Indonesia, it is the fourth most common female cancer with a 5-year survival rate of 45%, but can reach up to 92% if treated early. Granulosa cell tumors (GCT) arise from the sex-cord and are considered malignant. This study presents a rare case of asymptomatic adult-type granulosa cell tumor in an elderly lady diagnosed during routine pelvic ultrasound scanning. Case Illustration: A 65-year-old lady, P2A0, was referred due to left ovarian mass three years before admission. A left adnexal mass was palpated with no sign of internal genital adhesion. Transvaginal ultrasound showed atrophy of uterus and thin endometrial layer. One solid adnexal mass with a cystic part was found on the left adnexal with papillary projection and low resistance index. Histopathological examination revealed adult type-granulosa cell tumor and classical Call-Exner body with grooved nuclei (coffee bean nuclei). Diagnosis of GCT was made by histological findings. Discussion: Histologically, granulosa cells of adult subtype appear round, pale, with scant cytoplasm, classic coffee bean nuclei and Call-Exner bodies. In contrast, the juvenile subtype has eosinophilic and/or vacuolated cytoplasm with macrofollicular or cystic patterns, composed of immature granulosa cells with frequent mitoses. Call-Exner bodies and coffee bean grooved nuclei are not commonly found. Conclusion: The diagnosis of GCT was made through histological findings which were consistent with previous findings. Therefore, a laparotomy frozen section can be considered in menopausal women with suspected ovarian neoplasms.

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Adult‐type granulosa cell tumor of the ovary: a FOXL2 ‐centric disease

The Journal of Pathology Clinical Research ◽

10.1002/cjp2.198 ◽

2021 ◽

Author(s):

Jessica A Pilsworth ◽

Dawn R Cochrane ◽

Samantha J Neilson ◽

Bahar H Moussavi ◽

Daniel Lai ◽

...

Keyword(s):

Granulosa Cell ◽

Granulosa Cell Tumor ◽

Cell Tumor ◽

Adult Type

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Multiple recurrence of granulosa cell tumor of the ovary: A case report and literature review

10.1055/s-0039-1685319 ◽

2016 ◽

Author(s):

Varkha Chandra ◽

Sandhya Jain ◽

Neerja Goel ◽

Bindia Gupta ◽

Shalini Rajaram

Keyword(s):

Case Report ◽

Granulosa Cell ◽

Adnexal Mass ◽

Malignant Tumors ◽

Abdominal Mass ◽

Pelvic Mass ◽

Granulosa Cell Tumor ◽

Cell Tumor ◽

Surgical Staging ◽

Granulosa Cell Tumors

Introduction: Granulosa cell tumors comprise approximately 5% of all ovarian malignancy and account for 70% of malignant sex cord stromal tumors. Granulosa cell tumors have been diagnosed from infancy, the peak incidence being perimenopausal age. The potential of malignancy of these tumors is low, recurrences are often late and found in 10-33% of cases. Case Report: A 32-year-old P1L1 presented with large abdominal mass for which she underwent staging laparotomy with debulking surgery. She was a known case of granulosa cell tumor in the past and had undergone three laparotomies, along with chemotherapy. At the age of 13 yrs, she was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary first time. She underwent surgical staging and removal of left sided adnexal mass, after which she was asymptomatic for 7 years. In 2003 she again presented with lump abdomen for which she underwent resection of adnexal mass, histopathology was consistent with recurrent GCT. After second surgery she also received two cycles of chemotherapy. Despite adjuvant chemotherapy, patient presented again after three years in 2006 with adnexal mass and was found to have a third recurrence. At that time, she received 6 cycles of chemotherapy and the mass regressed. Meanwhile she got married and had one child. After four year in 2010 she again presented with lump abdomen and she underwent surgical staging, total abdominal hysterectomy with right salphingo ophorectomy along with removal of mass. After five year in 2015 she again presented with lump abdomen; there was a large pelvic mass which was removed and patient referred for chemotherapy. Discussion: GCTS which a rare malignant tumors of ovary tend to be associated with late recurrences. Although most recurrences occurs within 10 years after initial diagnosis, there are occasional reports of recurrences after10 years. We experienced the rare case of a patient who relapsed multiple times over 20 years, despite surgical and targeted treatment. Conclusion: The long history of granulosa cell tumor highlights the importance of extended follow up of the patient.

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Ovarian cysts and tumors as the cause of isosexual pseudoprecocious puberty

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh0608305m ◽

2006 ◽

Vol 134 (7-8) ◽

pp. 305-309 ◽

Cited By ~ 4

Author(s):

Katarina Mitrovic ◽

Dragan Zdravkovic ◽

Tatjana Milenkovic ◽

Katarina Sedlecki ◽

Zoran Stankovic

Keyword(s):

Luteinizing Hormone ◽

Granulosa Cell ◽

Precocious Puberty ◽

Granulosa Cell Tumor ◽

Central Precocious Puberty ◽

Bone Age ◽

Cell Tumor ◽

Ovarian Cysts ◽

Pelvic Ultrasound ◽

Releasing Hormone

Introduction. Precocious puberty in girls is generally defined as appearance of secondary sexual characteristics before eight years of age. Menarche before the ninth birthday may serve as an additional criterion. Precocious puberty is divided in central precocious puberty and pseudoprecocious puberty. Central precocious puberty (GnRH dependent) occurs because of premature activation of hypothalamic-pituitarygonadal axis and activity of gonadotrophins. Pseudoprecocious puberty (GnRH independent) is caused by activity of sexual steroids that are not the result of gonadotrophin activity. Objective. Objective of our study was to examine the etiology, clinical and laboratory manifestations of isosexual pseudoprecocious puberty in girls. Method. In the period between 1995 and 2004, clinical and laboratory sings of 34 girls with precocious puberty were studied at the Endocrine Department of the Institute of Mother and Child Health Care of Serbia. Initial evaluations included height measurement, staging of puberty, bone age assessment and pelvic ultrasound. Important diagnostic sonographic parameters of precocious puberty were the volumes of ovaries and uterus as well as ovarian structure. The initial hormonal evaluation included measuring of plasma oestradiol, luteinizing hormone (LH) and follicle stimulating hormone (FSH). The luteinizing hormone releasing hormone (LHRH) stimulation test was used to evaluate LH and FSH responsiveness (60 ?g/m2 LHRH- Relefact LHRH?, Ferring). Blood samples were collected at 0, 20 and 60 minutes. Basal and GnRH stimulated LH and FSH were determined by immunoradiometric assay. Estradiol concentration was measured using the fluoroimmunometric assay. Results. Thirty-four girls aged 6 months to 9 years (mean age 4.5 years) with precocious puberty were studied during the period of 9 years. Eleven girls presented with breast development, six with vaginal bleeding and seventeen with signs of puberty. On the basis of clinical signs, bone age, estradiol levels and LHRH test, premature the larche was diagnosed in eleven patients (32.4%), premature menarche in six (17.6%) and central precocious puberty in ten girls (29.4%). Seven girls (20.6%) presented with pseudoprecocious puberty. Pelvic ultrasound examination revealed unilateral ovarian cysts in six patients and granulosa cell tumor in one. Elevated estrogen serum levels and failure of gonadotropin responses after gonadotropin releasing hormone were the classical findings in patients with isosexual pseudoprecocious puberty during the acute period of disease. In four patients, the cyst decreased spontaneously after several months, while in two patients, the cyst was removed by laparotomy. Surgical treatment was performed in a patient with granulosa cell tumor. Conclusion. Our work demonstrates that autonomous functional ovarian follicle cyst is the most often cause of isosexual pseudoprecocious puberty. Short period of observation is suggested because the cyst can resolve spontaneously. On the other hand, juvenile granulosa cell tumor, as highly malignant tumor, should be removed as soon as diagnosis is established.

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Testicular Adult Type Granulosa Cell Tumor: A Very Rare Case Report and Review of Literature

Urology and Andrology - Open Journal ◽

10.17140/uaoj-1-103 ◽

2017 ◽

Vol 1 (1) ◽

pp. 12-14 ◽

Cited By ~ 2

Author(s):

Wei-Chieh Chen ◽

◽

Yun-Ho Lin ◽

Shauh-Der Yeh ◽

Chien-Chih Wu ◽

...

Keyword(s):

Case Report ◽

Granulosa Cell ◽

Rare Case ◽

Granulosa Cell Tumor ◽

Cell Tumor ◽

Review Of Literature ◽

Adult Type ◽

Rare Case Report

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Abstract B10: FOXL2 402C>G mutation can be identified in the circulating tumor DNA of patients with adult-type granulosa cell tumor.

10.1158/1557-3265.ovca15-b10 ◽

2016 ◽

Author(s):

Anniina Färkkilä ◽

Melissa K. McConechy ◽

Winnie Yang ◽

Aline Talhouk ◽

Ying Ng ◽

...

Keyword(s):

Granulosa Cell ◽

Granulosa Cell Tumor ◽

Circulating Tumor Dna ◽

Cell Tumor ◽

Adult Type ◽

Tumor Dna

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Characteristics and treatment results of recurrence in adult-type granulosa cell tumor of ovary

Journal of Ovarian Research ◽

10.1186/s13048-020-00619-6 ◽

2020 ◽

Vol 13 (1) ◽

Author(s):

Dan Zhao ◽

Yanan Zhang ◽

Zhengjie Ou ◽

Rong Zhang ◽

Shan Zheng ◽

...

Keyword(s):

Granulosa Cell ◽

Granulosa Cell Tumor ◽

Cell Tumor ◽

Treatment Results ◽

Adult Type

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Adult Type Ovarian Granulosa Cell Tumor

10.32388/aabu2f ◽

2020 ◽

Author(s):

Keyword(s):

Granulosa Cell ◽

Granulosa Cell Tumor ◽

Cell Tumor ◽

Adult Type ◽

Ovarian Granulosa Cell ◽

Ovarian Granulosa Cell Tumor

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Juvenile Granulosa Cell Tumor as the Presenting Feature of McCune-Albright Syndrome

Journal of the Endocrine Society ◽

10.1210/jendso/bvab098 ◽

2021 ◽

Author(s):

Brynn E Marks ◽

Ronan Sugrue ◽

Wallace Bourgeois ◽

A Lindsay Frazier ◽

Stephan D Voss ◽

...

Keyword(s):

Granulosa Cell ◽

Adnexal Mass ◽

Granulosa Cell Tumor ◽

Cell Tumor ◽

Pelvic Mri ◽

Mccune Albright Syndrome ◽

Fdg Uptake ◽

Juvenile Granulosa Cell Tumor ◽

Albright Syndrome ◽

Mccune Albright

Abstract Introduction GNAS mutations have been reprted in both McCune-Albright Syndrome (MAS) and juvenile granulosa cell tumors (JGCT), but have never been reported simultaneously in the same patient. Case Presentation A 15-year-old girl developed secondary oligomenorrhea. Laboratory studies revealed suppressed gonadotropin levels with markedly elevated estradiol and inhibin B levels. Pelvic ultrasound showed a 12-cm heterogeneous right adnexal mass; pelvic MRI to further characterize the mass displayed heterogeneous bilateral femoral bone lesions initially concerning for metastatic disease. PET/CT showed minimal fluorodeoxyglucose (FDG) uptake in the pelvic mass, but unexpectedly revealed FDG uptake throughout the skeleton, concerning for polyostotic fibrous dysplasia in the context of McCune-Albright Syndrome (MAS). The adnexal mass was excised and pathology confirmed a juvenile granulosa cell tumor (JGCT). The patient’s affected bone and JGCT tissue revealed the same pathogenic GNAS p.R201C mutation, while her peripheral blood contained wild type arginine at codon 201. Conclusion This mutation has been previously reported in cases of MAS and JGCT, but never simultaneously in the same patient. This demonstration of a GNAS mutation underlying both JGCT and MAS in the same patient raises questions about appropriate surveillance for patients with these conditions.

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