Unicystic Granulosa Cell Tumor

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/ by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Granulosa cell tumors are the most frequent sex cord stromal tumor and account for approximately 5% of all primary ovarian tumors. About 5% occur before puberty and 40% occur in the menopausal age group; however, these tumors have an indolent biological behavior. 1 The clinical presentation in most cases is due to estradiol secretion but some may be nonfunctional or may present with virilizing symptoms. Unilocular and multi-locular cystic granulosa cell tumors have been reported in the literature but are rare disease processes. A 57-year-old woman presented with lower abdominal pain and abdominal distention for 3 months duration. The patient reached menopause 10 years prior. She had no symptoms or signs of hyperestrinisim or virilization. Abdominal examination revealed a mass consistent with 20 weeks of pregnancy extending to the umbilicus. On palpation, the mass was mobile and cys-tic. Ultrasound examination showed a mixed echogenic mass measuring 13×8.8 cm, which arised from the left side of the pelvis (Fig. 1A). A computed tomography (CT) scan revealed a large cystic space occupying lesion with thick septa measuring 18.5×11.9×14.4 cm arising from the pelvis (Fig. 1B). A possible diagnosis of a mucinous cyst adenoma/carcinoma was made. Lab investigations were within normal limits with cancer anti-gen 125 levels being 5–12 U/mL (normal value, 0 to 35 U/mL). The patient underwent a total abdominal hysterectomy with bilateral salphingo-oopherectomy. Grossly, the left ovarian cyst measured 20×14×10 cm. The external surface of the cyst was smooth with prominent vasculature and the cut surface revealed a unilocular and thin-walled cyst filled with 500 mL of hemor-rhagic fluid. The inner surface was smooth with tiny focal pap-illary projections (Fig. 2). Histomorphology revealed a unicystic lesion lined by multi-layered granulosa cells with interspersed Call-Exner bodies (Fig. 3A, B). The neoplastic cells were round to polygonal with moderate to scant cytoplasm and round to oval nuclei with some showing prominent grooving (Fig. 3C). The immunohistochemical markers, inhibin and vimentin, were positive (Fig. 3D, E). A final diagnosis of unicystic granu-losa cell tumor was made. DISCUSSION Sex cord stromal tumors comprise approximately 8% of primary ovarian neoplasms, and among these tumors, the granulo-sa cell tumor is the most common and accounts for approximately 1.5% of …