Incidental diagnosis of an Adult Granulosa Cell Tumour of the ovary in a patient with
atypical endometrial hyperplasia
V.J. Meegoda1, K.G. Hewawitharana1, K.V.H. Nimana1, M A AM Jayawardane1,2
1University professorial unit of Obstetrics & Gynecology, Colombo South Teaching Hospital, Colombo, Sri Lanka, 2Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Lanka
INTRODUCTION
Adult granulosa cell tumours (AGCT) of the ovary are rare malignancies with good prognosis and a tendency for late recurrences. Manifestations of unopposed oestrogen is common with various degrees of endometrial hyperplasia.
CASE PRESENTATION
•A 51-year-old multipara presented with irregular heavy menstrual bleeding for four months.
•On gynecological examination, uterus was normal in size with age-appropriate cervix and normal adnexa.
•TVS revealed a thick endometrium of 15mm, with ultrasonically normal-looking ovaries on both sides with no evidence of free fluid.
•Patient underwent hysteroscopy, which showed polyps in endometrial cavity and was subjected to dilatation & curettage.
•Histology revealed atypical endometrial hyperplasia.
•As the patient had completed her family, a TAH + BSO was carried out.
•Histology of the specimen revealed AGCT of the ovary in addition to atypical endometrial hyperplasia.
DISCUSSION
•AGCT originates from proliferating normal preovulatory granulosa cells and retains ability to produce oestrogen, thus giving rise to menstrual abnormalities.
•This leads to early diagnosis, most at Stage-I, thus leading to favourable outcomes.
•Due to long-term exposure to endogenous oestrogen endometrial hyperplasia is common and around 2% develop endometrial cancer.
•Given the perimenopausal age, menstrual symptoms and abnormalities, the clinician is driven to exclude endometrial pathologies, but as in AGCT the primary cause could be an ovarian pathology.
•The serum level of CA-125, oestradiol, inhibin, and anti-Müllerian hormone are used in different capacities, but none has been correlated with tumour progression in large studies.
•The somatic missense mutations in the transcription factor FOXL2 is pathognomonic for AGCT.
•Evidence-based management of AGCT is limited, considering the rarity.
•Adjuvant radiotherapy, chemotherapy & hormone therapy may have a place in recurrent or extensive disease.
•In comparison to epithelial ovarian cancers, AGCT has a good prognosis (5-year survival-91.3%).
CONCLUSION
AGCT of the ovary is an uncommon neoplasm with a favourable prognosis and late recurrences. Surgery remains the mainstay of management
