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  Table of Contents    
CASE REPORT  
Year : 2020  |  Volume : 63  |  Issue : 3  |  Page : 470-471
Malignant granulosa cell tumor of testis with metastasis to liver: Case report and review of literature


Department of Pathology, RNT Medical College, Udaipur, Rajasthan, India

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Date of Submission13-Jul-2018
Date of Decision17-Jan-2019
Date of Acceptance28-Jan-2019
Date of Web Publication7-Aug-2020
 

   Abstract 


We report a case of testicular granulosa cell tumor of adult type in a 65-year-old male patient who has presented with hepatic metastasis. Although, this type of sex cord stromal tumor is relatively common in the ovaries, it is extremely unusual in the testis, and it probably represents the rarest type of testicular sex cord stromal tumor.

Keywords: Adult type, granulosa cell tumor, testicular

How to cite this article:
Bordiya S, Priyanka K, Garg D. Malignant granulosa cell tumor of testis with metastasis to liver: Case report and review of literature. Indian J Pathol Microbiol 2020;63:470-1

How to cite this URL:
Bordiya S, Priyanka K, Garg D. Malignant granulosa cell tumor of testis with metastasis to liver: Case report and review of literature. Indian J Pathol Microbiol [serial online] 2020 [cited 2020 Sep 21];63:470-1. Available from: http://www.ijpmonline.org/text.asp?2020/63/3/470/291671





   Introduction Top


Testicular neoplasms are diseases that can arise from germ cells, sex cord or stroma. Granulosa cell tumor of the adult testis is extremely rare, and its biological behavior is unclear.[1],[2],[3] This is described for the first time in 1952,[4] granulosa cell tumors are originated from epithelial elements of the sex cord, and they can be divided in juvenile or adult types.[3],[4],[5] granulosa cell tumors comprise less than 5% of ovarian tumors in women, and are much rarer in men only 45 cases have been previously reported.[1] As compared with their ovarian counterparts, these tumors may follow a more aggressive course.[3] Ultrasonography guided fine needle aspiration cytology (FNAC) is currently the most favored and increasingly used pre-operative diagnostic procedure in various deep seated neoplastic and non-neoplastic mass lesions, and it provides a good diagnostic yield for intra-abdominal masses.


   Case Report Top


A 65-year-old man, referred to us with a 2-year history of a mass in abdomen and pain abdomen without past history of trauma, infection, gastrointestinal or lower urinary tract symptoms. Physical examination revealed intra-abdominal mass in right hypochondrium region. Ultrasonography of abdomen showed multiple echogenic mass in liver, largest being 12 × 12 cm in size.

Under aseptic precautions, ultrasonography guided fine needle aspiration cytology (US-FNAC) was performed using 22 gauge, 90 mm spinal needle attached to a 10 ml disposable syringe. The prepared smears were stained with MGG stain.

Cytological examination showed hypercellular smears with both large and small overlapping cell clusters. Tumor cells were round to oval, with hyperchromatic nuclei containing granular chromatin, micronucleoli, and focal nuclear grooves. Microfollicular structures with central amorphous material seen – Call-Exener bodies [Figure 1] and [Figure 2].
Figure 1: Photomicrograph showing round to oval tumor cells forming microfollicular structures with central amorphous material (call-exner bodies), overlapping is also seen at some places (Giemsa 40×)

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Figure 2: Photomicrograph showing tumor cells round to oval with hyperchromatic nuclei containing granular chromatin, micronucleoli and focal nuclear grooves,forming microfollicular structure with central amorphous material (call-exner bodies). ( Giemsa 100×)

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   Discussion Top


Sex cord-stromal tumors of the gonads are numerous including thecomas, fibromas, Sertoli cell, Leydig cell, Sertoli-Leydig cell, and granulosa cell tumours (GCTs). GCT of testis is extremely rare and GCTs are divided into two different types: juvenile and adult type.[6],[7],[8] The juvenile type commonly occurs in the first 6 months of life. The adult type is very rare and can occur at any time after puberty. Adult granulosa cell testicular tumors (AGCTT) affect mainly in white males usually as a painless enlargement over a variable period of time in >50% of cases.[9] The mean (range) age at diagnosis is 47 (12–77) years. Erectile dysfunction, gynaecomastia, and decreased libido may also be present. Gynaecomastia is present in 25% of cases due to hormonal abnormalities such as estrogen hypersecretion, or chromosomal abnormalities.[5],[8],[9]

Some AGCTTs have the potential for distant metastases and thus poor outcomes, but otherwise they are non-functioning, slow growing, and most often benign. A relatively long survival period was found in patients with metastases to regional lymph nodes; however, deaths occurring at few months to a few years after metastases have occurred in patients that have distant metastasis and who exhibited rapid disease progression.[10] The retroperitoneal lymph nodes are the most common metastatic region, but lung, liver, and bone metastases have also been reported.[3],[10] More extensive follow-up may be warranted with larger tumors or tumors deemed to be aggressive. A follow-up protocol suggested is an abdominal and testicular sonography along with chest X-ray, with a CT of the abdomen and pelvis every 6 months. The duration of follow-up is not well-defined; however, long term follow-up is mandatory because metastasis has been found after 10 years of treatment.


   Conclusion Top


In summary, granulosa cell tumors with metastasis to live in an adult male is a rare disease, and precise pathological diagnosis is important for guiding treatment decisions.

Financial support and sponsorship

Nil.

Conflicts of interest

There is no conflicts of interest.



 
   References Top

1.
Elbachiri M, Taleb A, Derrabi N, Bouchbika Z, Benchakroun N, Jouhadi H, et al. Adult-type granulosa cell tumor of the testis: Report of a case and review of literature. Pan Afr Med J 2017;26:198.  Back to cited text no. 1
    
2.
Al-Bozom IA, El-Faqih SR, Hassan SH, El-Tiraifi AE, Talic RF. Granulosa cell tumor of the adult type: A case report and review of the literature of a very rare testicular tumor. Arch Pathol Lab Med 2000;124:1525-8.  Back to cited text no. 2
    
3.
Wang BY, Rabinowitz DS, Granato RC, Unger PD. Gonadal tumor with granulosa cell tumor features in an adult testis. Ann. Diagn Pathol 2002;6:56-60.  Back to cited text no. 3
    
4.
Hammerich KH, Hille S, Gustavo AE. Malignant advanced granulosa cell tumor of the adult testis: Case report and review of the literature. Hum Pathol 2008;39:701-9.  Back to cited text no. 4
    
5.
Hisano M, Souza FM, Malheiros DM, Pompeo AC, Lucon AM. Granulosa cell tumor of the adult testis: A report of a case and review of the literature. Clinics (Sao Paolo) 2006;61:77-8.  Back to cited text no. 5
    
6.
Majdoul S, Tawfiq N, Bourhaleb Z, Naqos N, Taleb A, Bouchbika Z, et al. Récidive après dix ans de tumeur de la granulosa de l'ovaire: À propos de deux cas et revue de la littérature. Pan Afr Med J 2016;25:30.  Back to cited text no. 6
    
7.
Arzola J, Hutton RL, Baughman SM, Mora RV. Adult-type testicular granulosa cell tumor: A case report and review of the literature. Urology 2006;68:1121.e13-6.  Back to cited text no. 7
    
8.
Miliaras D, Anagnostou E, Moysides I. Adult type granulosa cell tumor: A very rare case of sex-cord tumor of the testis with review of the literature. Case Rep Pathol 2013;932086. doi: 10.1155/2013/932086.  Back to cited text no. 8
    
9.
Lazrak I, Laachiri B, Meklaa A, Kouach J, Moussaoui D, Dehayni M. Granulosa cell tumor ovary. Int J Innov Appl Stud 2014;7:1020-4.  Back to cited text no. 9
    
10.
Ditonno P, Lucarelli G, Battaglia M, Mancini V, Palazzo S, Trabucco S, et al. Testicular granulose cell tumor of the adult type: A new case and review of the literature. Urologic Oncol 2007;25:322-5.  Back to cited text no. 10
    

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Correspondence Address:
Kumari Priyanka
Flat No. A-508, Miraj Malhar Apartment, New Bhupalpura, Udaipur - 313 001, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_436_18

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