Extraovarian Granulosa Cell Tumor of Mesentery: A Case Report

Extraovarian granulosa cell tumor (GCT) is a very uncommon tumor, assumed to arise from the ectopic gonadal tissue along the embryonal route of the genital ridge. A 54 years old female patient presented with a mass and acute pain in abdomen. Exploratory laparatomy revealed hemoperitoneum with a large mesenteric mass measuring 13 × 12？cm in size, showing extensive areas of haemorrhages. Histopathological examination of the excised mass showed features of adult-type GCT. As the patient had a history of hysterectomy with bilateral salpingo-oophorectomy 10 years ago for ‘‘leiomyoma’’ with no evidence of GCT of the ovary in the histopathology report, a diagnosis of extraovarian GCT was made. A diagnosis of extraovarian GCT should be carried out after excluding any previous history of GCT of the ovary. Tumor rupture with haemoperitoneum is a well-known complication of GCT. Extraovarian GCT is a rare tumor with only 10 cases reported in literature. The case is presented for its rarity. 1. Introduction Granulosa cell tumors (GCT) are the most common malignant sex cord—stromal tumors of the ovary [1]. They can arise in locations other than the ovary and may be derived from the mesenchyme of the genital ridge [2]. Women who have undergone oophorectomy may have the potential to develop GCT [2]. The primary extraovarian GCT is extremely rare tumor [3]. In the English literature only 10 cases have been reported to date [3, 4], including one case arising in a mullerian cyst of the broad ligament [5]. Ours is the eleventh case and third case from India [4, 6]. 2. Case Report A 54 years old female presented with mass and acute pain in abdomen. She gave a history of hysterectomy with bilateral salpingo-oophorectomy 10 years ago for uterine leiomyoma. Per abdominal examination revealed a vague mass palpable in epigastric and periumbilical region. On investigation, her hemoglobin was 8.6？gram% and total WBC count was 15,500？/cumm with neutrophilia. RBC morphology was hypochromic and microcytic on peripheral smear. Sonography of the abdomen showed a ？cm-sized solid heterogeneous mass in the mesentery. Exploratory laparatomy revealed hemoperitoneum with a large mesenteric mass measuring ？cm in size showing extensive areas of haemorrhages. The mass was removed. Gross findings—the mass was grayish brown, soft, and nodular with haemorrhagic areas measuring ？cm. Cut section revealed solid homogenous grayish white tumor with small cystic areas and areas of haemorrhages (Figure 1). Figure 1: grayish brown, soft, and nodular mass with haemorrhagic areas measuring ？cm. Cut section