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CASE REPORT Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 4  |  Page : 559-560
Granulosa cell tumor arising in an ovary with mature teratoma


1 Department of Pathology, The Gujarat Cancer and Research Institute, NCH Campus, Asarwa, Gujarat, India
2 Department of Gynecology, The Gujarat Cancer and Research Institute, NCH Campus, Asarwa, Gujarat, India

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Date of Web Publication1-Oct-2009
 

   Abstract 

Granulosa cell tumor (GCT) with synchronous mature teratoma is extremely rare and only eight cases are documented in the literature. GCT is low-grade malignancy and need a close follow up for recurrences which may be late. We report a case of GCT and mature teratoma occurring synchronously in the same ovary in a perimenopausal woman.

Keywords: Granulosa cell tumor, ovarian neoplasm, teratoma

How to cite this article:
Trivedi P, Patel T, Jain R, Parikh B, Dave P. Granulosa cell tumor arising in an ovary with mature teratoma. Indian J Pathol Microbiol 2009;52:559-60

How to cite this URL:
Trivedi P, Patel T, Jain R, Parikh B, Dave P. Granulosa cell tumor arising in an ovary with mature teratoma. Indian J Pathol Microbiol [serial online] 2009 [cited 2014 Dec 27];52:559-60. Available from: http://www.ijpmonline.org/text.asp?2009/52/4/559/56166



   Introduction Top


Adult granulosa cell tumor (GCT) accounts for 1-2% of all ovarian neoplasm and they are known for late recurrences, even after 10-20 years in some cases. [1] Teratoma accounts for approximately 15% of all ovarian tumors. GCT combined with dermoid cyst in the same ovary is rarely seen and has been considered to represent two independent neoplasms occurring synchronously. [2] To the best of our knowledge, only eight cases have been previously described. [2],[3],[4] We would like to report an additional case.


   Case Report Top


A 48-year-old perimenopausal woman presented with lower abdominal pain with irregular off and on bleeding per vagina for two months preceded by six months of amenorrhea. On examination, lower abdominal mass arising from pelvis was palpable which was reaching up to umbilicus. It was mobile per vaginal examination. Ultra sonography examination revealed 12 Χ 12 cms sized predominantly solid left adenaxal mass. Uterus was bulky and endometrium thickness was 25 mm. Preoperative serum estradiol and CA-125 was 113.40 pg/ml and 11.45 IU/ml, respectively. She underwent dilatation and curettage; histopathology report was suggestive of disordered proliferative endometrium. She underwent total abdominal hysterectomy with bilateral salphingoophrectomy and omentectomy. Ovarian mass was sent for frozen section and was reported as germ cell tumor, possibility of primary carcinoid with area of other mature teratomatous component or mixed tumor (GCT + teratoma). Postoperatively three cycles of chemotherapy (cisplatin, etoposide, and bleomycin) was given. The patient is alive and disease free to date.

Grossly, left ovarian mass was well encapsulated measuring 15 Χ 15 Χ 5 cms in size. Cut surface was predominantly solid and partially cystic from which sero-sanguinous fluid came out. Hair tuft, bone, and cartilage were also present [Figure 1]. Capsule was intact. Uterus, cervix, right ovary, and both  Fallopian tube More Detailss were grossly unremarkable and free of tumor.

Microscopically, solid component was extremely cellular and composed of sheets of closely packed, monotonous looking round to oval cells lobulated by fibrous septa. Tumor also showed trabecular, cords, and insular pattern. Cells showed eosinophilic cytoplasm and relatively uniform pale nuclei, many of which had prominent grooves. Call-Exner bodies were present at places. Necrosis and mitosis were absent. Cystic area showed mature squamous epithelium, colonic mucosa, cartilage, bone, salivary, and breast tissues [Figure 2]. Immature tissues were not seen. On immunohistochemistry, vimentin, alfa inhibin, calretinin were positive [Figure 3] while cytokeratin (CK), carcinoembryonic antigen (CEA), CD99, placental alkaline phosphatase (PLAP), epithelial membrane antigen (EMA), chromogranin, and synaptophysin were negative. A diagnosis of GCT arising in an ovary with mature cystic teratoma was given. Right ovary, fallopian tubes, cervix, and omentum were histologically unremarkable. Endometrium showed changes consistent with disordered proliferative endometrium


   Discussion Top


GCT and mature cystic teratoma are independent tumor arising from sex cord stromal cells and germ cells, respectively. They occasionally occur synchronously in the same ovary or in contra lateral ovary. [2],[5] To the best of our knowledge, only eight cases of GCT and mature teratoma have been documented in the literature. In our case, adult type GCT and mature teratoma occur synchronously in the same ovary.

Mature teratomas are benign tumors but GCT are low grade malignancies. This rare malignancy responds well to surgery and postoperative chemotherapy including bleomycin, etoposide, and cisplatin. Recurrences can occur many years after removal of primary tumor, therefore patients need regular and long-term follow-up. [1],[6]

Occasionally GCT presents as a small lesion in cystic teratoma which could easily be missed through inadequate sections, so ovaries with mature cystic teratoma should be examined thoroughly for small foci of GCT. [2]


   Conclusion Top


We report a rare ovarian neoplasm composed of an admixture of mature teratoma and granulosa cell tumor. This association warrants close follow up of patient as recurrences can occur many years after removal of primary tumor.


   Acknowledgements Top


The authors wish to express their thanks to Dr. P.M. Shah, Honorary Director, Dr. K.M. Patel, Dr. S.N. Shukla and Dr. R.I. Dave, Deputy Directors of The Gujarat Cancer& Research Institute to allow us to publish this scientific data.

 
   References Top

1.Spencer HW, Mullings AM, Char G, Carpenter R. Granulosa-theca cell tumors of the ovaries. A late metastasizing tumor. West Indian Med J 1999;48:33-5.  Back to cited text no. 1      
2.Dgani R, Rozenman D, Lifschitz-Mercer B. Granulosa cell tumor arising in an ovary with mature cystic teratoma. Int J Gynaecol Obstet 1993;3:287-9.  Back to cited text no. 2      
3.Thompson JP, Dockerty MS, Symmonds RE. Granulosa cell carcinoma arising in a Cystic Teratoma of the ovary. Obstet Gynecol 1966;28:549-52.  Back to cited text no. 3      
4.Char G, Ramjit C, Fletcher H, Harvey W. Granulosa cell tumor of the ovary with bilateral mature cystic teratomas. West Indian Med J 2004;53:135-7.  Back to cited text no. 4      
5.Balat O, Aydin A, Kutlar L, Camcr C. Ruptured granulosa cell tumor of the left ovary and mature cystic teratoma of right ovary-A case report of unusual acute abdominal syndrome. Eur J Gynaec Oncol 2001;22:350-1.  Back to cited text no. 5      
6.Bjorkholm E, Petterson F. Granulosa-cell and theca-cell tumors. The clinical picture and long-term outcome for the Radiumhemmet series. Acta Obstet Gynecol Scand 1980;59:361-5.  Back to cited text no. 6      

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Correspondence Address:
Priti Trivedi
Room # 412, Department of Pathology, The Gujarat Cancer and Research Institute NCH Campus, Asarwa, Ahmadabad- 380 016, Gujarat
India
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DOI: 10.4103/0377-4929.56166

PMID: 19805973

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    Figures

  [Figure 1], [Figure 2], [Figure 3]

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    Abstract
    Introduction
    Case Report
    Discussion
    Conclusion
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    References
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