Gastric Metastasis of an Ovarian Granulosa Cell Tumor (GCT) Diagnosed in a Patient Presenting With Worsening Reflux

Abstract

GCT is a rare sex cord-stromal tumor and constitutes approximately 2-3% of all ovarian malignancies. Adult GCT accounts for 95% of all GCTs. Distant metastases from GCT are rare and to the best of our knowledge this is the first reported case of gastric metastasis from GCT presenting as multiple gastric polyps. 60-year-old female with history of reflux, hypertension, inferior vena cava thrombus on lovenox, granulosa cell tumor diagnosed 2 years ago s/p Total Abdominal Hysterectomy with Bilateral Salpingo-Oophorectomy, omental biopsy showing T1a NX M0 adult granulosa cell tumor presented to GI clinic with worsening reflux symptoms and loss of appetite for 3 weeks. Computed tomography (CT) chest was concerning for esophageal mass. EGD showed multiple gastric polyps, most of them had white colored tops with patches of necrotic appearing mucosa, no esophageal mass (Figure 1). Biopsy of gastric polyps showed ulcer with associated atypical epithelioid and spindle cell proliferation, favor metastasis from known granulosa cell tumor. CT chest, abdomen and pelvis showed bilateral metastatic pulmonary nodules, enlarged paraesophageal and periaortic lymph node. Brain metastasis was noted on MRI. Patient was deemed poor surgical candidate. She was started on systemic chemotherapy. She subsequently presented with worsening nausea, vomiting and abdominal pain. Repeat imaging showed worsening metastases. Radiation oncology was consulted for possible radiation of brain and paraesophageal mass. However patient decided to go forward with hospice. GCT have low malignant potential and late relapse. They are associated with a favorable prognosis, especially when they are detected in the early stages. The recurrence rates ranges between 9 and 35% and is associated with a poor prognosis. Although most recurrences are within 10 years after the initial diagnosis, there are reports of recurrence after 10 years. So, patients should be kept on a long-term follow-up protocol even if the primary tumor is occult. Spread is largely within the pelvis and the lower abdomen. Distant metastases are rare with few reported cases of lung, liver, brain, bone, diaphragm, abdominal wall, adrenal gland and supraclavicular lymph node metastasis from ovarian tumors. Patients with advanced metastatic GCTs, are typically treated with aggressive surgical resection followed by postoperative systemic chemotherapy. Radiation therapy may have some effect in cases with minimal residual disease.Figure: EGD showed multiple gastric polyps with patches of necrotic appearing mucosa.