Pelvic ultrasound scanning in asymptomatic adult-type granulosa cell tumor: A case report and review

Abstract

Background: Ovarian cancer is common amongst women worldwide. In Indonesia, it is the fourth most common female cancer with a 5-year survival rate of 45%, but can reach up to 92% if treated early. Granulosa cell tumors (GCT) arise from the sex-cord and are considered malignant. This study presents a rare case of asymptomatic adult-type granulosa cell tumor in an elderly lady diagnosed during routine pelvic ultrasound scanning.

Case Illustration: A 65-year-old lady, P2A0, was referred due to left ovarian mass three years before admission. A left adnexal mass was palpated with no sign of internal genital adhesion. Transvaginal ultrasound showed atrophy of uterus and thin endometrial layer. One solid adnexal mass with a cystic part was found on the left adnexal with papillary projection and low resistance index. Histopathological examination revealed adult type-granulosa cell tumor and classical Call-Exner body with grooved nuclei (coffee bean nuclei). Diagnosis of GCT was made by histological findings.

Discussion: Histologically, granulosa cells of adult subtype appear round, pale, with scant cytoplasm, classic coffee bean nuclei and Call-Exner bodies. In contrast, the juvenile subtype has eosinophilic and/or vacuolated cytoplasm with macrofollicular or cystic patterns, composed of immature granulosa cells with frequent mitoses. Call-Exner bodies and coffee bean grooved nuclei are not commonly found.

Conclusion: The diagnosis of GCT was made through histological findings which were consistent with previous findings. Therefore, a laparotomy frozen section can be considered in menopausal women with suspected ovarian neoplasms.