J Pathol Transl Med.  2018 Sep;52(5):344-348. 10.4132/jptm.2018.06.28.

Ovarian Gynandroblastoma with a Juvenile Granulosa Cell Tumor Component in a Postmenopausal Woman: A Case Report and Literature Review

Affiliations
  • 1Department of Pathology, Yeungnam University School of Medicine, Daegu, Korea. clodious@naver.com
  • 2Department of Gynecology and Obstetrics, Yeungnam University School of Medicine, Daegu, Korea.
  • 3Department of Pathology, Fatima Hospital, Daegu, Korea.

Abstract

Gynandroblastoma is an extremely rare sex cord-stromal tumor with both female (granulosa cell tumor) and male (Sertoli-Leydig cell tumor) elements. Juvenile granulosa cell tumors are also very rare and are so named because they usually occur in children and adolescents. A 71-year-old woman with right upper quadrant abdominal pain visited our hospital. Pelvic computed tomography showed a large multilocular cystic mass, suspected to be of ovarian origin. We performed a total abdominal hysterectomy (total abdominal hysterectomy was performed) with bilateral salpingo-oophorectomy. A 13-cm multilocular cystic mass with serous fluid was observed in her right ovary. Upon microscopic examination, the solid component of the mass showed both Sertoli-Leydig cell and juvenile granulosa cell differentiation, which we diagnosed as gynandroblastoma. Gynandroblastoma with a juvenile granulosa cell tumor component is extremely rare and, until now, only six cases have been reported in the English literature. We report the first gynandroblastoma with a juvenile granulosa cell tumor component diagnosed in an elderly patient, along with a literature review.

Keyword

Ovarian gynandroblastoma; Juvenile granulosa cell tumor; Ovary; Postmenopause

MeSH Terms

Abdominal Pain
Adolescent
Aged
Child
Female
Granulosa Cell Tumor*
Granulosa Cells*
Humans
Hysterectomy
Male
Ovary
Postmenopause
Sex Cord-Gonadal Stromal Tumors*

Figure

  • Fig. 1. Pelvic computed tomography (CT) and ultrasonography findings. (A) Pelvic CT reveals a large multilocular cystic mass (arrow) with a solid component. (B) Ultrasonography shows a cystic mass (arrow) of approximately 13 cm arising from the right adnexa.

  • Fig. 2. Gross findings. (A) A 13.0×7.5×6.5-cm multilocular cystic and solid mass replaced the entire ovary. (B) The cysts were filled with serosanguinous fluid and approximately 30% of the mass was solid, hard, and yellow.

  • Fig. 3. Microscopic findings. (A) The tumor was composed of a Sertoli-Leydig cell tumor (SLT) and a juvenile granulosa cell tumor (JGCT). (B) The JGCT shows solid and nodular growth patterns with relatively uniform tumor cells. (C) Various sized follicles with mucin-like basophilic secretions are also frequently observed. (D) The tumor cells were rounded and had hyperchromatic nuclei without nuclear grooves, which are the characteristic features of adult granulosa cell tumors. (E) A well-differentiated SLT component is also identified. (F) Sertoli cells formed hollow tubules with delicate fibrous stroma. Small clusters of Leydig cells are observed in the fibrous stroma. (G, H) The immunohistochemical staining results confirms that the tumor was of sex cord-stromal origin. Both components stained positive for calretinin (G, left, SLT; right, JGCT) and inhibin (H, left, SLT; right, JGCT).


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