A case of postmenopausal bleeding with an unusual finding

Abstract

Authors report the case of a 55-year-old patient who presented with postmenopausal bleeding. On clinical evaluation uterus was 12 weeks size with a left sided adnexal cystic mass of 8 × 6 cm size. Further imaging studies revealed uterus size of 11.5 × 6.7 × 6.3 cm, left ovarian mass of size 8.4 × 6.7 × 6 cm and endometrial thickness of 17 mm on ultrasonography. She underwent endometrial biopsy to exclude endometrial cancer. The report of which came to be endometrial hyperplasia without atypia. Further MRI study confirmed the findings of USG of a complex cystic lesion of left adnexa 75 × 57 × 60 mm. Tumor marker for ovarian tumors were sent and inhibin B was found to be markedly raised. A provisional diagnosis of GCT (Granulosa cell tumour) was made and staging laparotomy was done. The uterus was found to be 12 × 8 cm size and a left sided ovarian cyst of 8-9 cm size with smooth wall and intact capsule was found. Patient had an uneventful postoperative recovery.

Three Different Ways to Miss a Granulosa Cell Tumor – A Lesson to be Learne

“…An endometrial biopsy should be performed to rule out the possibility of a coexistent endometrial adenoacinoma. For perimenopausal and postmenopausal women, only TAH BSO is sufficient [3]. For the use of adjuvant radiotherapy, controversial results exists.…”

“…Based on there clinicopathological characteristics they are classified as adult (AGCTs) and juvenile (JGCTs). AGCTs account for approximately 1% to 2% of all ovarian tumors and 95% of all GCTs [2] AGCTs (95%) almost always occur in postmenopausal women while JGCTs (5%) are diagnosed under 30 years of age and maybe seen in prepubertal girls in 5% of cases [3]. These are often low grade malignancies and are usually diagnosed in early stages, but with an awkward biological potential for late…”