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 Table of Contents  
CASE REPORT
Year : 2018  |  Volume : 4  |  Issue : 2  |  Page : 49-50

Recurrent Granulosa Cell Tumour of The Ovary in Postmenopausal Women - A Rare Case Report


1 Senior Resident, Department of Gynecological Oncology, IGIMS, Patna, India
2 Additional Professor, Department of Gynecological Oncology, IGIMS, Patna, India
3 Additional Professor, Department of Pathology, IGIMS, Patna, India
4 Professor Anesthesiology, IGIMS, Patna, India

Date of Web Publication10-Dec-2020

Correspondence Address:
Sangeeta Pankaj
Additional Professor, Dept. Gynecological Oncology, IGIMS, Patna, Bihar
India
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Source of Support: None, Conflict of Interest: None


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  Abstract 


Granulosa cell tumour (GCT) is an uncommon low grade malignant neoplasm. It primarily arises from the sex-cord stromal cells of the ovary and produces oestrogen in most of the cases. They manifest themselves with pain and pressure symptoms due to expansile growth on adjacent organs. Granulosa cell tumours usually produce oestrogens, and leads to symptoms and signs of oestrogen excess. Granulosa cell tumour (GCT) is characterized by a relatively low malignant potential, slow growth, less aggressive and late recurrence; however prognosis is influenced by many factors, such as age and stage at presentation, tumour size, necrosis, mitotic activity and histological staging. We report a case of GCT in postmenopausal woman having history of previous two laparotomy for ovarian mass.

Keywords: Granulosa Cell Tumour (GCT), Laparotomy, Malignant Potential, Ovary, Perimenopausal, Postmenopausal, Sex Cord Stromal Tumours


How to cite this article:
Kumari J, Pankaj S, Kumari A, Nazneen S, Kumari A, Choudhary V, Raghwendra K H. Recurrent Granulosa Cell Tumour of The Ovary in Postmenopausal Women - A Rare Case Report. J Indira Gandhi Inst Med Sci 2018;4:49-50

How to cite this URL:
Kumari J, Pankaj S, Kumari A, Nazneen S, Kumari A, Choudhary V, Raghwendra K H. Recurrent Granulosa Cell Tumour of The Ovary in Postmenopausal Women - A Rare Case Report. J Indira Gandhi Inst Med Sci [serial online] 2018 [cited 2021 Dec 4];4:49-50. Available from: http://www.jigims.co.in/text.asp?2018/4/2/49/302956




  Introduction: Top


Granulosa cell tumours (GCTs) are very uncommon tumour and account for about 1-2% of all ovarian neoplasms[1],[2]. Overall incidence of GCT varies from 0.4 to 1.7 cases per 100,000 women.[3] It arises from the sex-cord stromal cells of the ovary and is hormonally active, oestrogen - secreting tumours. Generally the prognosis is good but these patients need regular follow up due to late recurrence. It can recur or metastasize many years after initial treatment and rarely develop at an extra ovarian site, even in an oophorectomized patient.[4] Granulosa cell tumors usually produce estrogens, and leads to symptoms and signs of estrogen excess. Endometrial hyperplasia and adenocarcinoma of uterus are reported in 50 % and 15% of the cases of GCT respectively in peri-menopausal and postmenopausal women. Majority of patients with GCT are diagnosed at an early stage of the disease and have more specific symptoms and signs of either hyperestrogenism or hyperandrogenism unlike epithelial tumors where diagnosis is delayed due to vague and nonspecific presentations. We hereby report an unusual case of granulosa cell tumour in postmenopausal woman presenting us with recurrent ovarian lump after 15 years. Final diagnosis was done here by histopathological examination. She did not have not any specific symptom by which she could be diagnosed earlier.

Case report- A 62yrs old female patient, P10+0 came to our Institute with complain of lump in lower abdomen for 2 months associated with loss of appetite and constipation for 2 months. She attained her menopause 25yrs back at the age of 37 years. In postmenopausal period she had undergone laparotomy twice about 15yrs ago when total abdominal hysterectomy and bilateral salpingo oophorectomy was done again laparotomy was done for abdominal mass and at 10 yrs for similar complain (abdominal mass) respectively. Her histopathological report of second surgery was reported as granulosa cell tumour. Abdominal examination revealed a mobile lump of 5×6 cm in right iliac fossa. On per speculum examination vault was smooth and lump of 10 cm was felt through vault by vaginal examination. CT scan revealed post- hysterectomised status with bilateral adnexal mass and left iliac lymphadenopathy. The laboratory investigations including hematocrit, leukocytes, platelets, kidney function tests, electrolytes and liver function tests were within normal. Her blood group was B positive, CA 125-5.50 IU/ml (0-35 IU/ml), CEA - 1.2 ng/ml (0-2.5ng/ml) , LDH- 143IU/ml (<200IU/ml) , CA 19-9 - 15IU/ml (0-37IU/ml) , AFP - 3.07ng/ml(0-40 ng/ml) , Beta HCG - 1.83 mIU/ml (0-5 mIU/ml), TSH -1.09mIU/ml (0.5 -4 mIU/ml). At our Institute she had undergone exploratory laparotomy, her intraoperative findings were two lumps, first one was of size 5 × 4cm in right side of the pelvis adhered to bowel serosa and bladder which was resected. Another loculated mass of size 10 ×12cm was fixed in pelvis densely adhered to sigmoid colon and was not resectable.

HPE report [Figure 1] showed granulosa cell tumour which was confirmed by immunohistochemistry (IHC). As the mass was not removed completely, so patient was sent for chemotherapy to medical oncology dept. where she received platinum based chemotherapy. She came to us for follow up twice for one year after which she did not turn up.
Figure 1: Shows small bland cuboidal cells arranged in follicular, trabecular and solid pattern.

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  Discussion: Top


Ovarian GCT is a rare neoplasm constituting 2 to 5% of all ovarian malignancies. Its incidence is 0.5 - 1.5 per 1, 00,000 women per year. In our Institute 165 ovarian cancer (OC) patients were operated in last 3 yrs. of them this was the only case of GCT of ovary which was proven histologically and hence accounting 0.60% of OC.

Clinico-pathologically GCT of ovary is of two subtypes adult and juvenile. Adult variant is the commonest accounting to 95% occurring in peri (40-45 years) and post-menopausal women (>45 years) with peak incidence at 50-55 years[5] but recurrences are rare and late. Juvenile GCTs are rare neoplasm comprising 5% of all GCTs occurring in the pre pubertal age group[6] and recurrences are common and early. They are frequently unilateral, bilateral occurrence is less than 5%. In this case, patient had bilateral recurrent adult GCT which is very rare.

GCT is the most common hormone-producing ovarian tumour. Their hormone activity has different symptoms: menorrhagia, menometrorrhagia, amenorrhea, endometrial hyperplasia, endometrial CA or fibrocystic disorder of breasts[6]. Differential diagnoses include undifferentiated carcinoma ovary, adenocarcinoma, cellular fibroma, cellular thecoma and carcinoid. On microscopy, Call-Exner bodies, nuclear grooves and coffee bean nuclei are pathognomonic diagnostic features of GCT. Somatic mutations of FOXL2 Gene seen in 97 % cases of adult granulosa cell tumour. On Immunohistochemistry (IHC), GCT shows positivity for Inhibin and Calretinin; variable positivity with S100.

The primary treatment of patients with GCTs is always surgical. The large number of recurrent tumours is limited to lower pelvis and abdomen. Postoperative monitoring is conducted at intervals of 2-3 months in the first 2 years for patients with no chemotherapy or every 3-6 months in the next 3 years. Chemotherapy and/or radiotherapy are implemented in later stages of illness or in patients with recurrence. The prognosis of GCT is generally good. Almost 90% of GCT is in the stage I at the moment of diagnosis. The survival rate for GCTs in the stage I within ten- year period is 90-96%, and in later phases, the survival for the same period of time is only 33-44%. Five-year survival rate is 90%.


  Conclusion: Top


In our case we report a late recurrence of granulosa cell tumour in postmenopausal women which was the single case in our institute in last 3 yrs. She did not have any specific symptom which could simulate GCT. She was operated twice previously for similar complains of abdominal mass 10 and 15 yrs back respectively. Final diagnosis was done here by histopathological examination. Early diagnosis followed by surgical treatment results in good prognosis with 20 years survival rate is more than 70%. Histopathological examination forms the definitive diagnostic modality.



 
  References Top

1.
Ashnagar A, Alavi S, Nilipour Y, et al. Massive ascites as the only sign of ovarian juvenile granulosa cell tumour in an adolescent: a case report and a review of the literature. Case Rep Oncol Med. 2013; 2013: 386725. Published online 2013 Jan 29. doi: 10.1155/2013/ 386725  Back to cited text no. 1
    
2.
Ali Abuseini, Nabeh Al-Kaisi. Extra-Ovarian Granulosa Cell Tumor: a Case Report. JRMS September 2014; 21(4): 66-68 / DOI: 10.12816/0005531.  Back to cited text no. 2
    
3.
Calcaterra V, Nakib G, Pelizzo G, et al. Central precocious puberty and granulosa cell ovarian tumour in an 8-year old female. Pediatr Rep. 2013;5(3):e13.  Back to cited text no. 3
    
4.
Kottarathil VD, Antony MA, Nair IR, Pavithran K; Recent Advances in Granulosa Cell Tumour Ovary: A Review. Indian Journal of Surgical Oncology, 2013; 4(1): 37-47.  Back to cited text no. 4
    
5.
Ukah CO, Ikpeze OC, Eleje GU, Eke AC. Adult granulosa cell tumor associated with endometrial carcinoma: A case report. J Med Case Rep. 2011;5:340  Back to cited text no. 5
    
6.
Adhikari RC, Jha A, Shayami G. Granulosa cell tumor of the ovary: A clinicopathological study of six cases. J Pathol Nepal. 2011;1:96-9.  Back to cited text no. 6
    


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