Adult-Type Granulosa Cell Tumor with Similar Clinical Findings Seen during Ovarian Cystectomy Performed at the Same Time as Laparoscopic Ovarian Drilling for Polycystic Ovarian Syndrome: An Extremely Rare Case
Polycystic ovary syndrome (PCOS) is a major cause of anovulatory infertility. Laparoscopic ovarian drilling (LOD) is a treatment for PCOS that allows the laparoscopic identification of other intra-abdominal lesions and the provision of diagnostic treatment. This study reports a case of PCOS with an ovarian mass in which LOD was aggressively used and a granulosa cell tumor (GCT) was found. A 34-year-old woman with secondary amenorrhea and irregular menstrual cycles presented to the emergency department with abdominal pain of unknown etiology. Imaging studies revealed a 6-cm left ovarian mass with an internal appearance suggestive of a hemorrhage. The patient’s secondary amenorrhea was subsequently diagnosed as PCOS, and LOD was performed to preserve her fertility. Simultaneously, a cystectomy was performed to evaluate the tumor in the left ovary; the diagnosis was adult-type GCT. Although concomitant GCT and PCOS are extremely rare, the two conditions have similar clinical manifestations. In women of reproductive age, the impact of surgery on future fertility should be considered, and the initial surgical technique should be chosen carefully.
References
[1]
March, W.A., Moore, V.M., Willson, K.J., Phillips, D.I.W., Norman, R.J. and Davies, M.J. (2009) The Prevalence of Polycystic Ovary Syndrome in a Community Sample Assessed under Contrasting Diagnostic Criteria. Human Reproduction, 25, 544-551. https://doi.org/10.1093/humrep/dep399
[2]
Dumont, A., Robin, G., Catteau-Jonard, S. and Dewailly, D. (2015) Role of Anti-Müllerian Hormone in Pathophysiology, Diagnosis and Treatment of Polycystic Ovary Syndrome: A Review. Reproductive Biology and Endocrinology, 13, Article No. 137. https://doi.org/10.1186/s12958-015-0134-9
[3]
Frandsen, C.L.B., Svendsen, P.F., Nøhr, B., Viuff, J.H., Maltesen, T., Kjær, S.K., et al. (2023) Risk of Epithelial Ovarian Tumors among Women with Polycystic Ovary Syndrome: A Nationwide Population-Based Cohort Study. International Journal of Cancer, 153, 958-968. https://doi.org/10.1002/ijc.34574
[4]
Triantafyllidou, O., Sigalos, G., Oikonomou, I. and Vlahos, N. (2018) Ovarian Granulosa Cell Tumor and Clomiphene Citrate Resistance. a Case Report and Review of the Literature. JBRA Assisted Reproduction, 22, 381-384. https://doi.org/10.5935/1518-0557.20180056
[5]
Kim, Y.S. and Lee, J.H. (2021) A Case Report of Ovarian Granulosa Cell Tumor in Patient with Polycystic Ovarian Syndrome. Medicine, 100, e28261. https://doi.org/10.1097/md.0000000000028261
[6]
Li, J., Chu, R., Chen, Z., Meng, J., Yao, S., Song, K., et al. (2021) Progress in the Management of Ovarian Granulosa Cell Tumor: A Review. Acta Obstetricia et Gynecologica Scandinavica, 100, 1771-1778. https://doi.org/10.1111/aogs.14189
[7]
Sun, H., Lin, H., Jao, M., Wang, K., Liou, W., Hung, Y., et al. (2012) A Long-Term Follow-Up Study of 176 Cases with Adult-Type Ovarian Granulosa Cell Tumors. Gynecologic Oncology, 124, 244-249. https://doi.org/10.1016/j.ygyno.2011.10.015
[8]
Schumer, S.T. and Cannistra, S.A. (2003) Granulosa Cell Tumor of the Ovary. Journal of Clinical Oncology, 21, 1180-1189. https://doi.org/10.1200/jco.2003.10.019
[9]
Wang, D., Cao, D., Jia, C., Huang, H., Yang, J., Wu, M., et al. (2018) Analysis of Oncologic and Reproductive Outcomes After Fertility-Sparing Surgery in Apparent Stage I Adult Ovarian Granulosa Cell Tumors. Gynecologic Oncology, 151, 275-281. https://doi.org/10.1016/j.ygyno.2018.09.004
[10]
Bryk, S., Färkkilä, A., Bützow, R., Leminen, A., Heikinheimo, M., Anttonen, M., et al. (2015) Clinical Characteristics and Survival of Patients with an Adult-Type Ovarian Granulosa Cell Tumor: A 56-Year Single-Center Experience. International Journal of Gynecologic Cancer, 25, 33-41. https://doi.org/10.1097/igc.0000000000000304
[11]
Collée, J., Mawet, M., Tebache, L., Nisolle, M. and Brichant, G. (2021) Polycystic Ovarian Syndrome and Infertility: Overview and Insights of the Putative Treatments. Gynecological Endocrinology, 37, 869-874. https://doi.org/10.1080/09513590.2021.1958310
[12]
Naz, R.K. (2014) Polycystic Ovary Syndrome Current Status and Future Perspective. Frontiers in Bioscience, 6, 104-119. https://doi.org/10.2741/e695
[13]
Mercorio, A., Della Corte, L., De Angelis, M.C., Buonfantino, C., Ronsini, C., Bifulco, G., et al. (2022) Ovarian Drilling: Back to the Future. Medicina, 58, Article No. 1002. https://doi.org/10.3390/medicina58081002
[14]
Lebbi, I., Ben Temime, R., Fadhlaoui, A. and Feki, A. (2015) Ovarian Drilling in PCOS: Is It Really Useful? Frontiers in Surgery, 2, Article No. 30. https://doi.org/10.3389/fsurg.2015.00030
[15]
Kawamura, M., Akiyama, M., Nakajima, R., Satoi, E., Ogaki, Y. and Kanda, R. (2024) Usefulness of Newly Devised Clomiphene Citrate Administration Method Compared with the Conventional Method in Ovulation and Pregnancy. Open Journal of Obstetrics and Gynecology, 14, 637-649. https://doi.org/10.4236/ojog.2024.144055
[16]
Debras, E., Fernandez, H., Neveu, M., Deffieux, X. and Capmas, P. (2019) Ovarian Drilling in Polycystic Ovary Syndrome: Long Term Pregnancy Rate. European Journal of Obstetrics & Gynecology and Reproductive Biology: X, 4, Article ID: 100093. https://doi.org/10.1016/j.eurox.2019.100093
[17]
Morley, L.C., Tang, T., Yasmin, E., Norman, R.J, and Balen, A.H. (2017) Insulin-Sensitising Drugs (Metformin, Rosiglitazone, Pioglitazone, D-Chiro-Inositol) for Women with Polycystic Ovary Syndrome, Oligo Amenorrhoea and Subfertility. Cochrane Database of Systematic Reviews, 11, CD003053.
[18]
Porestsky, L., Levesque, L., Seibel, M.M., Smith, D., Pazianos, A., Hurd, J., Aretz, T. and Flier, J. (1988) Characteristics of in Vitro Steroidogenesis in a Women with Hyoerandrogenesm, a Granulosa Cell Tumor and Polycystic Ovary Disease: A Case Report. The Journal of Reproductive Medicine, 33, 377-381.
[19]
Gu, C., Zeng, X., Shi, Q., Xiao, Q. and He, Y. (2022) Androgen-Secreting Adult Granulosa Cell Tumor in a Woman with Polycystic Ovary Syndrome: A Case Report. Gynecological Endocrinology, 38, 1014-1016. https://doi.org/10.1080/09513590.2022.2143491
[20]
Vera, L., Accornero, M., Mora, M., Valenzano-Menada, M., Minuto, F. and Giusti, M. (2013) Increasing Hirsutism Due to a Granulosa-Cell Tumor in a Woman with Polycystic Ovary Syndrome: Case Report and Review of the Literature. Gynecological Endocrinology, 29, 273-277. https://doi.org/10.3109/09513590.2012.743012
[21]
Harris, A.A. and Kabadi, U.M. (2020) More than Meets the Eye in a Patient with PCOS: Androgen-Secreting Granulosa Cell Ovarian Tumor in a Virilized Woman with Polycystic Ovarian Syndrome (PCOS). AACE Clinical Case Reports, 6, e170-e173. https://doi.org/10.4158/accr-2019-0576
[22]
Morikawa, K., Hatabu, H., Togashi, K., Kataoka, M.L., Mori, T. and Konishi, J. (1997) Granulosa Cell Tumor of the Ovary: MR Findings. Journal of Computer Assisted Tomography, 21, 1001-1004. https://doi.org/10.1097/00004728-199711000-00028
[23]
Kim, S.H. and Kim, S.H. (2002) Granulosa Cell Tumor of the Ovary: Common Findings and Unusual Appearances on CT and Mr. Journal of Computer Assisted Tomography, 26, 756-761. https://doi.org/10.1097/00004728-200209000-00016
[24]
Nyberg, D.A., Porter, B.A., Olds, M.O., Olson, D.O., Andersen, R. and Wesby, G.E. (1987) MR Imaging of Hemorrhagic Adnexal Masses. Journal of Computer Assisted Tomography, 11, 664-669. https://doi.org/10.1097/00004728-198707000-00021
[25]
Erkılınç, S., Taylan, E., Karataşlı, V., Uzaldı, İ., Karadeniz, T., Gökçü, M., et al. (2019) Does Lymphadenectomy Effect Postoperative Surgical Morbidity and Survival in Patients with Adult Granulosa Cell Tumor of Ovary? Journal of Obstetrics and Gynaecology Research, 45, 1019-1025. https://doi.org/10.1111/jog.13928
[26]
Ray-Coquard, I., Morice, P., Lorusso, D., Prat, J., Oaknin, A., Pautier, P., et al. (2018) Non-Epithelial Ovarian Cancer: ESMO Clinical Practice Guidelines for Diagnosis, Treatment and Follow-Up. Annals of Oncology, 29, iv1-iv18. https://doi.org/10.1093/annonc/mdy001
[27]
Ebina, Y., Yamagami, W., Kobayashi, Y., Tabata, T., Kaneuchi, M., Nagase, S., et al. (2021) Clinicopathological Characteristics and Prognostic Factors of Ovarian Granulosa Cell Tumors: A JSGO-JSOG Joint Study. Gynecologic Oncology, 163, 269-273. https://doi.org/10.1016/j.ygyno.2021.08.012
[28]
Chelariu-Raicu, A., Cobb, L.P. and Gershenson, D.M. (2021) Fertility Preservation in Rare Ovarian Tumors. International Journal of Gynecologic Cancer, 31, 432-441. https://doi.org/10.1136/ijgc-2020-001775