The hidden face of ovarian cysts: a case of incidentally detected granulosa cell tumor

The hidden face of ovarian cysts: a case of incidentally detected granulosa cell tumor DOI: https://doi.org/10.18203/2320-1770.ijrcog20253925Keywords: Adult granulosa cell tumor, Ovarian neoplasm, Sex cord-stromal tumor, Immunohistochemistry, Inhibin, SF1, CalretininAbstract Adult granulosa cell tumors (AGCTs) are rare ovarian sex cord–stromal neoplasms that constitute 1–2% of ovarian malignancies and are often diagnosed late due to their nonspecific clinical, radiological, and biochemical features. We describe the case of a 50-year-old perimenopausal woman who presented with abnormal uterine bleeding and was found on ultrasound to have an endometrial polyp and a benign-appearing ovarian cyst, with normal tumor markers. She underwent laparoscopy-assisted vaginal hysterectomy with bilateral salpingo-oophorectomy, after which histopathological examination unexpectedly revealed an adult granulosa cell tumor in the left ovary, characterized by classic Call-Exner bodies and grooved (“coffee-bean”) nuclei. Immunohistochemistry demonstrated strong positivity for SF1 and Calretinin with focal Inhibin expression, confirming the diagnosis. The patient was staged as FIGO IA and placed on surveillance. This case highlights the importance of routine histopathological evaluation of adnexal masses even when preoperative findings appear benign, and underscores the need for long-term follow-up because AGCTs carry a risk of late recurrence. Metrics References Young RH. Ovarian sex cord-stromal tumors and their mimics. Pathology. 2018;50(1):5-15. DOI: https://doi.org/10.1016/j.pathol.2017.09.007 Schumer ST, Cannistra SA. Granulosa cell tumor of the ovary. J Clin Oncol. 2003;21(6):1180-9. DOI: https://doi.org/10.1200/JCO.2003.10.019 Jamieson S, Fuller PJ. Management of granulosa cell tumour of the ovary. Curr Opin Oncol. 2008;20(5):560–4. DOI: https://doi.org/10.1097/CCO.0b013e328306316f van Meurs HS, van Lonkhuijzen LRCW, Limpens J, et al. Granulosa cell tumor recurrence: a systematic review and meta-analysis. Gynecol Oncol. 2014;134(3):497–504. DOI: https://doi.org/10.1016/j.ygyno.2014.03.573 Mangili G, Ottolina J, Gadducci A, Giorda G, Breda E, Savarese A, et al. Long-term follow-up is crucial after treatment for granulosa cell tumours of the ovary. Br J Cancer. 2013;109(1):29-34. DOI: https://doi.org/10.1038/bjc.2013.241 Geerts I, Vergote I, Neven P, Billen J. The role of inhibins B and antimüllerian hormone for diagnosis and follow-up of granulosa cell tumors. Int J Gynecol Cancer. 2009;19(5):847–55. DOI: https://doi.org/10.1111/IGC.0b013e3181a702d1 Zhang M, Cheung MK, Shin JY, Kapp DS, Husain A, Teng NN, et al. Prognostic factors responsible for survival in sex cord stromal tumors of the ovary--an analysis of 376 women. Gynecol Oncol. 2007;104(2):396-400. DOI: https://doi.org/10.1016/j.ygyno.2006.08.032 Suematsu S, Tanaka T, Ogura A, Ito K. Adult granulosa cell tumor of the ovary discovered after surgery for presumed benign disease: A case report. Int J Surg Case Rep. 2024;115:110729. Salkeni MA, Shin S, Takebe N, Stevens S, Chen A. Advanced Granulosa Cell Tumors of the Ovary: A Review with a Focus on Current and Novel Therapeutic Approaches. J Immunother Precis Oncol. 2024;7(4):263-71. DOI: https://doi.org/10.36401/JIPO-23-40 Plett H, Ricciardi E, Vacaru V, Ramspott JP, Colombo N, Sehouli J, et al. Adult ovarian granulosa cell tumors: analysis of outcomes and risk factors for recurrence. Int J Gynecol Cancer. 2023;33(5):734-40. DOI: https://doi.org/10.1136/ijgc-2022-003854