Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature
Objective: To report a case of stage IIIB juvenile granulosa cell tumor (JGCT) complicating pregnancy in a 33 year-old (y.o.) woman. Methods: Retrospective review of the clinical data, imaging studies, and pathology reports of a case of JGCT diagnosed during pregnancy. Patient consent was obtained f...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-04-01
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| Series: | Gynecologic Oncology Reports |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2352578923000334 |
| _version_ | 1797850882416574464 |
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| author | Mackenzie Cummings Pamela Edmonds Mark S. Shahin Joel I. Sorosky |
| author_facet | Mackenzie Cummings Pamela Edmonds Mark S. Shahin Joel I. Sorosky |
| author_sort | Mackenzie Cummings |
| collection | DOAJ |
| description | Objective: To report a case of stage IIIB juvenile granulosa cell tumor (JGCT) complicating pregnancy in a 33 year-old (y.o.) woman. Methods: Retrospective review of the clinical data, imaging studies, and pathology reports of a case of JGCT diagnosed during pregnancy. Patient consent was obtained for review and presentation of the case. A literature review was conducted. Results: A 33 y.o., gravida 3, para 1 was incidentally found to have an 8 cm left ovarian mass on an anatomy scan at 22 weeks gestation. Four days later, she presented to labor and delivery triage with abdominal pain. An ultrasound revealed an 11 cm heterogeneous, solid mass in the left adnexa and free fluid at this level. The diagnosis of degenerating fibroid was made based on her clinical presentation and she was discharged. A follow up outpatient MRI revealed a 15 cm left ovarian mass consistent with a primary malignant ovarian neoplasm with moderate ascites and omental, left cul de sac, and probable paracolic gutter implantation. She re-presented 2 weeks later with an acute abdomen and was admitted for a gynecologic oncology consult. Pre-op tumor markers showed an elevated inhibin B. She underwent an exploratory laparotomy, left salpingo-oophorectomy, omental biopsy, and small bowel resection at 25 weeks gestation. Intra-op findings included a ruptured tumor and metastases. Tumor reductive surgery was completed to R0. Pathology revealed a JGCT, FIGO stage IIIB. The pathology and management were reviewed in collaboration with an outside institution. Chemotherapy was delayed until after delivery with monthly MRI surveillance. She underwent induction of labor at 37 weeks followed by an uncomplicated vaginal delivery. She received 3 cycles of bleomycin, etoposide, and cisplatin starting six weeks postpartum. Last known contact was over five years after the initial diagnosis with no evidence of recurrent disease. Conclusion: JGCTs account for 5% of granulosa cell tumors and 3% are diagnosed after age 30. JGCT is an uncommon neoplasm in pregnancy. 90% are stage I at diagnosis, but advanced stage tumors are aggressive often resulting in recurrence or death within 3 years of diagnosis. We present a surgically treated case with delay in chemotherapy until after delivery with a good outcome after 5 years of follow up. |
| first_indexed | 2024-04-09T19:08:47Z |
| format | Article |
| id | doaj.art-088ab0a6b4404661bbc84de672ecb18b |
| institution | Directory Open Access Journal |
| issn | 2352-5789 |
| language | English |
| last_indexed | 2024-04-09T19:08:47Z |
| publishDate | 2023-04-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Gynecologic Oncology Reports |
| spelling | doaj.art-088ab0a6b4404661bbc84de672ecb18b2023-04-07T06:50:29ZengElsevierGynecologic Oncology Reports2352-57892023-04-0146101164Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literatureMackenzie Cummings0Pamela Edmonds1Mark S. Shahin2Joel I. Sorosky3Jefferson Abington Hospital, Department of Obstetrics and Gynecology, United States; Corresponding author.Jefferson Abington Hospital, Department of Pathology, United StatesHanjani Institute for Gynecologic Oncology, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center at Thomas Jefferson University, United StatesHanjani Institute for Gynecologic Oncology, Asplundh Cancer Pavilion of Sidney Kimmel Cancer Center at Thomas Jefferson University, United StatesObjective: To report a case of stage IIIB juvenile granulosa cell tumor (JGCT) complicating pregnancy in a 33 year-old (y.o.) woman. Methods: Retrospective review of the clinical data, imaging studies, and pathology reports of a case of JGCT diagnosed during pregnancy. Patient consent was obtained for review and presentation of the case. A literature review was conducted. Results: A 33 y.o., gravida 3, para 1 was incidentally found to have an 8 cm left ovarian mass on an anatomy scan at 22 weeks gestation. Four days later, she presented to labor and delivery triage with abdominal pain. An ultrasound revealed an 11 cm heterogeneous, solid mass in the left adnexa and free fluid at this level. The diagnosis of degenerating fibroid was made based on her clinical presentation and she was discharged. A follow up outpatient MRI revealed a 15 cm left ovarian mass consistent with a primary malignant ovarian neoplasm with moderate ascites and omental, left cul de sac, and probable paracolic gutter implantation. She re-presented 2 weeks later with an acute abdomen and was admitted for a gynecologic oncology consult. Pre-op tumor markers showed an elevated inhibin B. She underwent an exploratory laparotomy, left salpingo-oophorectomy, omental biopsy, and small bowel resection at 25 weeks gestation. Intra-op findings included a ruptured tumor and metastases. Tumor reductive surgery was completed to R0. Pathology revealed a JGCT, FIGO stage IIIB. The pathology and management were reviewed in collaboration with an outside institution. Chemotherapy was delayed until after delivery with monthly MRI surveillance. She underwent induction of labor at 37 weeks followed by an uncomplicated vaginal delivery. She received 3 cycles of bleomycin, etoposide, and cisplatin starting six weeks postpartum. Last known contact was over five years after the initial diagnosis with no evidence of recurrent disease. Conclusion: JGCTs account for 5% of granulosa cell tumors and 3% are diagnosed after age 30. JGCT is an uncommon neoplasm in pregnancy. 90% are stage I at diagnosis, but advanced stage tumors are aggressive often resulting in recurrence or death within 3 years of diagnosis. We present a surgically treated case with delay in chemotherapy until after delivery with a good outcome after 5 years of follow up.http://www.sciencedirect.com/science/article/pii/S2352578923000334Juvenile granulosa cell tumorAdultOvarian malignancyPregnancy |
| spellingShingle | Mackenzie Cummings Pamela Edmonds Mark S. Shahin Joel I. Sorosky Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature Gynecologic Oncology Reports Juvenile granulosa cell tumor Adult Ovarian malignancy Pregnancy |
| title | Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature |
| title_full | Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature |
| title_fullStr | Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature |
| title_full_unstemmed | Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature |
| title_short | Juvenile granulosa cell tumor in an adult woman during pregnancy: A case report and review of the literature |
| title_sort | juvenile granulosa cell tumor in an adult woman during pregnancy a case report and review of the literature |
| topic | Juvenile granulosa cell tumor Adult Ovarian malignancy Pregnancy |
| url | http://www.sciencedirect.com/science/article/pii/S2352578923000334 |
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