Adult granulosa cell tumor: A sinister differential for clomiphene-resistant infertility

Abstract

Granulosa cell tumors (GCTs) are rare sex cord–stromal tumors of the ovary. They may present with features of hyperestrogenism. We present a case of a 29-year-old nulliparous female, with infertility and oligomenorrhoea, initially managed with a provisional diagnosis of polycystic ovarian syndrome. She did not respond to multiple cycles of ovulation induction with clomiphene citrate. Later, an ovarian mass was detected, and she was initially planned for laparoscopy. Magnetic resonance imaging pelvis revealed a solid-looking mass in the ovary, with increased vascularity. Fine-needle aspiration cytology from the mass suggested GCT. She underwent staging laparotomy with fertility-preserving surgery. Thereafter, she conceived on first cycle of clomiphene citrate. She delivered twins and is presently 8 months postpartum. Thus, a high index of suspicion for underlying androgen- or estrogen-secreting tumor in cases of clomiphene-resistant infertility with ovarian cysts is advisable.

Secondary Amenorrhea and Infertility Due to an Inhibin B Producing Granulosa Cell Tumor of the Ovary. A Rare Case Report and Literature Review

“…Additionally, patients with GCT present in 50% of cases endometrial hyperplasia due to the high levels of estrogens, therefore transvaginal ultrasound examination is recommended to assess the endometrial thickness and decide if endometrial biopsy is necessary [ 3 , 21 ]. Endometrial cancer is diagnosed in 5–13% cases [ 22 ].…”

“…In patients of reproductive age, when fertility preservation is desired, for early FIGO stages (IA) GCT, unilateral oophorectomy with multiple peritoneal biopsies, and washing cytology is acceptable. The complete surgical treatment is postponed after childbearing and completion of family planning [ 12 , 21 ]. In Stage IA postoperative treatment is not necessary, due to the good prognosis, adjuvant chemotherapy being offered in advanced stages.…”

“…After surgery, if fertility was spared, the hormones levels return to normal. Long-term follow-up with clinical examination, US and inhibin B levels is recommended due to the late recurrence tendency of GCTs [ 21 , 28 ].…”

“…Granulosa cell tumors are hormonally active tumors, causing transient infertility as shown in our case. An associated risk factor for infertility was the proximal obstruction of the left tube while the right tube was normal with positive methylene-blue test during laparoscopy [ 21 ].…”

Familial Occurrence of Adult Granulosa Cell Tumors: Analysis of Whole-Genome Germline Variants

“…Patients may develop symptoms, such as vaginal bleeding, caused by prolonged estrogen exposure or abdominal pain. Occasionally, a granulosa cell tumor is diagnosed in patients presenting with subfertility, potentially as a result of unregulated inhibin secretion by the tumor [ 3 , 4 ]. Although granulosa cell tumors can occur at any age, they mostly present perimenopausal or early in postmenopause, with a median age of diagnosis between 50 and 54 years [ 2 ].…”