Granulosa cell tumour of the ovary
Deirdre Murphy, University Hospital Southampton NHS Trust
Background
A 48-year-old patient was referred by her GP to the Ultrasound Department for an urgent pelvic ultrasound scan querying ovarian pathology. The patient presented with abdominal distension and pain. Blood tests revealed suppressed FSH/LH but normal oestrogen levels. She also had been experiencing irregular heavy bleeding over the past six months which she believed was associated with the menopause.
Case Report
Her ultrasound report revealed a thickened (23mm), inhomogeneous endometrium with multiple, interspersed cystic spaces. The endocervix also had an unusual appearance with evidence of multi-cystic change and endo-cervical expansion. A 162 x 102 x 116mm avascular, multilocular ovarian cyst with appearances suggestive of a mucinous cystadenoma was identified in the left adnexa. A mixed solid and cystic vascular mass measuring 107 x 81 x 86mm was identified in the right adnexa. Appearances suggested an ovarian malignancy. A CT scan was performed and reported a suspicious 113mm solid right ovarian mass, marked endometrial thickening and an unusual cervical appearance. This raised the possibility of a secreting sex cord stromal ovarian tumour. A 170mm multilocular minimally complex left adnexal cystic mass was also noted. No measurable lymphadenopathy or evidence of metastatic disease.
Discussion
The patient was admitted and had an emergency hysterectomy, bilateral salpingo-oophorectomy and omentectomy. It was later confirmed that she had a granulosa cell tumour of the ovary, which secretes the female hormone oestrogen. This causes symptoms such as abnormal vaginal bleeding and endometrial hyperplasia, which was this patient’s original presentation. Adult granulosa cell tumours are diagnosed in middle-aged and older women, typically occurring during the perimenopausal or postmenopausal years. They are slow-growing malignant tumours that can spread locally within the peritoneum and may recur in 25% of patients.