Acta Medica Medianae (Oct 2007)
RECURRENT MICROSCOPIC GRANULOSA CELL TUMOR OF THE OVARY 21 YEARS AFTER INITIAL OPERATION
Abstract
Granulosa cell tumors of the ovary are rare hormonally active neoplasms characterized by endocrine manifestations, an indolent course, and late relapse. These tumors have preponderance for local spread and extremely late recurrence and high survival rates. Late recurrence can be extensive with initial, clinically undetectable, microscopic granulosa cell tumor of the ovary. Only a small percentage of such tumors metastasize.We report a case of a 71-year-old woman with extensive recurrent granulosa cell tumor of the ovary 21 years after undergoing abdominal hysterectomy and bilateral salpingo-oophorectomy for atypical endometrial hyperplasia. 20 years after the initial treatment, she was well without evidence of the disease. 21 years after the initial treatment, abdominal pain was abrupt followed by unstable vital signs. Under the impression of internal bleeding, immediate laparotomy was performed. Macroscopic examination revealed predominantly cystic mass filled with clotted blood and separated by solid tissue. Biopsy showed granulosa cell tumor of the ovary. A thorough staging surgery included lymph node sampling, partial omentectomy and excision of any suspicion lesions within the abdominal cavity. The final pathologic expertise confirmed malignant granulosa cell tumor of the ovary. At the pathohystological re-expertise of the first operation material, the diagnosis of the initial, microscopic granulosa cell tumor of the ovary was confirmed. By pathological analysis of the second operation material, the diagnosis of malignant granulosa cell tumor of the ovary was confirmed. Autors describe a case of microscopic granulosa cell tumor of the ovary, which recurred 21 years after the original surgery. Late recurrence can be extensive with initial, clinically undetectable, microscopic granulosa cell tumor of the ovary. Patients must be monitored closely after a diagnosis of ovarian granulosa cell tumor, even if the tumor is occult. This case report emphasises the need for long-term follow-up in patients with granulosa cell tumors of the ovary and considers the possibility of recurrence when presented with acute abdomen after conservative treatment.
