Abnormal Elevation of Anti-Mullerian Hormone and Androgen Levels Presenting as Granulosa Cell Tumor.

Hongbin Chi,Congrong Liu,Jie Qiao,Rong Li,Huamao Liang,Ning Huang

doi:10.3389/fonc.2021.641166

Hongbin Chi, Congrong Liu + Show 4 more

Open Access

https://doi.org/10.3389/fonc.2021.641166

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Abstract

We report a rare subtype of adult cystic granulosa cell tumor (AGCT) characterized by elevated anti-Mullerian hormone and hyperandrogenism. A 35-year-old woman with primary infertility, hyperandrogenism, and irregular menses who was previously diagnosed with polycystic ovarian syndrome was diagnosed with AGCT based on histopathological examination and FOXL2 genetic test after laparoscopy. Due to fertility aspirations, she underwent controlled ovarian stimulation followed by embryo cryopreservation before salpingo-oophorectomy, and two embryos were frozen-thawed and transferred after surgery. A healthy female infant was delivered at 40 weeks’ gestation. Cystic granulosa cell tumors should be considered a differential diagnosis in patients with persistent ovarian cysts and hyperandrogenism. Younger patients with AGCT with fertility goals should consider active assisted reproduction measures to preserve fertility before treatment for AGCT.

Highlights

Adult granulosa cell tumor (AGCT) of the ovary is a rare type of ovarian tumor that originates from ovarian sex-cord stromal cells and represents approximately 3–5% of malignant ovarian tumors [1]
AGCT is rarely considered in the differential diagnosis of patients with elevated anti-Mullerian hormone (AMH) levels; instead, patients with elevated AMH levels and hyperandrogenism are more likely to be diagnosed with polycystic ovarian syndrome (PCOS), which is much more common
We report the management of a patient with AGCT characterized by infertility, abnormally elevated AMH levels, and hyperandrogenism

Summary

INTRODUCTION

Adult granulosa cell tumor (AGCT) of the ovary is a rare type of ovarian tumor that originates from ovarian sex-cord stromal cells and represents approximately 3–5% of malignant ovarian tumors [1]. (L) An axial T1-weighted image with fat saturation of the delayed phase obtained after gadolinium administration shows persistent enhancement of the solid component of the tumor. A preoperative MRI of the pelvis revealed a mass in the left adnexa measuring 4.6 × 3.8 × 4.9 cm with significant enhancement of the cyst wall and septum (Figure 1). These findings suggested a left ovarian tumor. Gonadal hormone levels were measured, and a transvaginal ultrasound was performed on day 2 of the menstrual cycle before initiating the process of ovarian stimulation. This study was approved by the Peking University Third Hospital Medical Science Research Ethics Committee and a written informed consent has been obtained from the patient

DISCUSSION

Findings

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