Multiple Recurrence of Granulosa Cell Tumor of the Ovary: A Case Report and Review of the Literature

Abstract

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, recurrence are often late and found in 10-33% of cases. A 32-year-old female para 1 live 1 presented with large abdominal mass fourth time in her lifetime for which she underwent staging laparotomy with debulking surgery. Histopathology of mass collected which was suggestive of granulosa cell tumor. She had three laparotomy for same region in the past. At 13 year of age she was diagnosed with a stage IA granulosa cell tumor (GCT) of the ovary first time. For which she underwent surgical staging and removal of adnexal mass, after that she was asymptomatic for 7 years. In 2003 she again presented with lump abdomen for which she underwent a resection of adnexal mass, histopathology was consistent with recurrent GCT. After second surgery she also received two cycles of chemotherapy. Despite adjuvant chemotherapy treatment the patient presented again after three years in 2006 with adnexal mass and was found to have a third recurrence. For which she received 6 cycles of chemotherapy and mass was regressed. After four year in 2010 she again presented with lump abdomen for which she underwent surgical staging total abdominal hysterectomy with right salphingo ophorectomy with removal of mass. After five year in 2015 she again presented with lump abdomen for which surgical management was done. So over the 20 years this patient had multiple recurrences and progressive disease despite surgical and targeted treatment. In conclusion the long history of granulosa cell tumor highlights the importance of extended follow up of the patient.