Three Different Ways to Miss a Granulosa Cell Tumor – A Lesson to be Learne

Abstract

Granulosa cell tumours (GCTs) account for approximately 70% of malignant sex-cord stromal tumors but are still uncommon and comprise only 2–5% of all ovarian neoplasms. They are classified as adult and juvenile GCTs. These are often low grade malignancies and are usually diagnosed in early stages, but with an potential for late recurrence. Case 1: A 51-year woman with c/o PMB with biopsy showing endometrial polyp. She underwent a total abdominal hysterectomy and a bilateral salpingo-oophorectomy (TAH BSO) with omental biopsy after intraoperative pathology confirmation of a Adult granulosa cell tumor (AGCT) of the ovary. She had a good post-operative recovery and was advised for regular and long term follow up. Case 2: A 63-year woman c/o PMB with an adult granulosa cell tumor that initially presented as endometrial hyperplasia on biopsy. She underwent a TAH BSO and omental biopsy after intraop frozen section confirmed of AGCT of the ovary. She had an uneventful post-operative recovery. Case 3: A 68-year womanwith an AGCT that was initially treated as endometrial carcinoma. She underwent a Comprehensive Surgical Staging due to initial misdiagnosis of endometrial carcinoma. Her final biopsy report showed it to be a granulosa cell tumor of the ovary and adenocarcinoma of the endometrium. She had a good post-operative recovery and is being followed up till now. The multifaceted presentations with its erratic biological behaviour coupled with late recurrences are diagnostic pitfalls necessitating a high degree of suspicion for accurate clinical diagnosis.