Year : 2009 | Volume
: 52 | Issue : 4 | Page : 559--560
Granulosa cell tumor arising in an ovary with mature teratoma
Priti Trivedi1, Trupti Patel1, Rohit Jain1, Biren Parikh1, Pariseema Dave2,
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
Room # 412, Department of Pathology, The Gujarat Cancer and Research Institute NCH Campus, Asarwa, Ahmadabad- 380 016, Gujarat
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.
|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;52:559-560
|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 2021 Sep 26 ];52:559-560
Available from: https://www.ijpmonline.org/text.asp?2009/52/4/559/56166
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.  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.  To the best of our knowledge, only eight cases have been previously described. ,, We would like to report an additional case.
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 tubes 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
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. , 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. ,
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. 
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.
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.
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