Granulosa cell tumor of the ovary.

A 38-year-old woman who had regular follow-up for infertility and had received two failed in vitro fertilizations was examined in our clinic. She had a history of diabetes mellitus and hypertension and had surgery for a double uterus several years ago. Sonography of the right ovary revealed a 10 cm cystic tumor. Right ovarian cystectomy was performed and an ovarian cystic tumor with pelvic adhesions was noted. Histopathologic examination revealed polygonal tumor cells with occasional nuclear grooves in trabecular, solid, microfollicular patterns and Call-Exner bodies (Figs. 1 and 2). The cells were diffusely positive for alpha-inhibin and CD99, and focally positive for pancytokeratin. An adult type granulosa cell tumor (GCT) was diagnosed. Magnetic resonance imaging showed a residual multilocular cystic tumor in the right ovary (Fig. 3). She received a salpingo-oophorectomy and a GCT, FIGO Stage IC1, was present in the residual ovary. Adjuvant chemotherapy was suggested due to incomplete resection. She has received further chemotherapy and follow-up for 7 months.

Fig. 1

Histopathology reveals tumor cells in trabecular, solid, microfollicular patterns and Call-Exner bodies (hematoxylin-eosin stain, ×200).

Fig. 2

Tumor cells with nuclear grooves are present (hematoxylin-eosin stain, ×400).

Fig. 3

Magnetic resonance imaging shows a multilocular cystic tumor.

A GCT is one type of sex cord-stromal tumor, and comprises 2–5% of ovarian malignancies. GCTs occur in patients over a wide age range and can be divided into adult (95%) and juvenile (5%) types. The adult subtype commonly occurs in postmenopausal women. It can have a late recurrence, and has been detected > 20 years after the initial diagnosis. The juvenile type usually occurs in the first 3 decades. Patients present with abdominal distension, menorrhagia, and metrorrhagia, related to hyperestrogenism. For Stage IA patients, surgery alone is the acceptable treatment. For Stage IC to IV disease, there is no standard therapy. Some groups recommend platinum-based chemotherapy, while others do not recommend postoperative therapy and treat only after a tumor recurrence. The pelvis is the most common site of recurrence. The prognosis depends upon the stage of disease at diagnosis. Unfavorable factors include bilateral tumors, tumor rupture, and advanced stage.