Granulosa Cell Tumour

Topics: Ovarian cancer, Cancer, Oncology Pages: 6 (1841 words) Published: September 1, 2013
A rare Case of bilateral Granulosa Cell Tumours of both ovaries of differing histopathological variety

Dr. Saswati Mukhopadhyay
DNB (G & O)
Assistant professor,
ESI PGI MSR, Joka,
Kolkata

Corresponding address:
Dr. Saswati Mukhopadhyay
Flat 16/4B Genexx Valley
Diamond Harbour Rd,
P. O. Joka
Kolkata 700104
email add. mukhopadhyay_saswati@rediffmail.com

Abstract
Granulosa Cell Tumour arises from the granulosa cells of the ovary. They belong to sex cord stromal tumours and are of two types – adult and juvenile varieties. They grow slowly, have low malignant potential, and may recur. We present a rare case of bilateral adult variety granulosa cell tumour of the ovaries.

Key Words: Low malignant potential, late recurrence, Sex cord stromal tumours

Introduction
Granulosa-theca cell tumors, more commonly known as granulosa cell tumors (GCTs), belong to the sex cord–stromal category. Although granulosa cells normally occur only in the ovary, granulosa cell tumours occur in both ovaries and testicles GCTs account for approximately 2% of all ovarian tumors and can be divided into adult (95%) and juvenile (5%) types based on histologic findings. Inhibin, the specific tumour marker for GCT, is used for diagnosis & tumor surveillance after treatment to assess for residual or recurrent disease. Although inhibin A and inhibin B levels can both be elevated in patients with granulosa cell tumors, inhibin B level is usually elevated in a higher proportion of these tumors. GCTs are tumors of low malignant potential. Most of these tumors follow a benign course, with only a small percentage showing aggressive behaviour. Metastatic disease can involve any organ system, although tumor growth is usually confined to the abdomen and pelvis. Case report

A 53yr. old postmenopausal lady, P1+0 , presented in our gynoe. OPD with pain abdomen, flatulence and loss of appetite for 3months. Abdominal examination revealed a hard, nontender mass with restricted mobility, measuring 15 x 12 cm. extending from symphysis pubis upto umbilicus. On pelvic examination, a solid mass was palpated in right fornix, extending into the pouch of douglas. Uterus was not felt separately from the mass; left fornix was free. Routine haemogram, urinalysis, liver & renal function tests were within normal levels. CA125 value was raised to 265.6IU/ml. Sonography indicated a highly vascular SOL of heterogenous nature measuring 170 x 151mm. arising from right pelvic wall, extending into the abdominal cavity. A subserous myoma of 35 x 31mm. size was seen in uterus; small amount of ascitic fluid was found in peritoneal cavity. FNAC report of the mass revealed clusters of discreet atypical cells in papillary & glandular pattern, with nucleomegaly, clumped chromatin and hyperchromasia, consistent with the picture of adenocarcinoma. Intraoperatively, moderate amount of clear fluid was found & sent for cytology. A mass was seen, arising from the right adnexa, occupying the whole abdominal cavity, having a partly cystic partly solid consistency, with a haemorrhagic, irregular surface, severely adherent to the small intestine and caecum. The right fallopian tube was stretched across the surface of the tumour. After adhesiolysis, the mass was removed intact; the uterus, left ovary and left tube appeared normal, exploration of abdominal viscera revealed no metastatic deposits except for a 3cm. x 2.5cm. size nodule on the pylorus of stomach. Total abdominal hysterectomy, left salpingo-oophorectomy and excision of the tumour mass was done. Pelvic and para-aortic lymph nodes were palpated but were not found to be enlarged. Patient had an uneventful postoperative period, stitches were removed on 7th postoperative day. The tumour was clinically staged at stage IIIc. Histopathology report showed adult granulose cell tumour of microfollicular, macrofollicular and insular pattern in the right ovary; and adult granulosa cell tumour of...
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