Metastasis of the liver with a granulosa cell tumor of the ovary: A case report

Abstract

The present study describes the case of a 62 year-old female patient with a metastatic tumor in the right hemi-liver of >25 cm in diameter, who presented to The Affiliated Hospital of Guilin Medical University (Guangxi, China) with acute abdominal pain and severe malnutrition. Radical surgery was performed to remove the tumor by open surgery. A biopsy was not performed prior to the surgery, so the tumor was diagnosed as end-stage primary liver cancer (PLC) based solely on the character and appearance of the tumor on computed tomography prior to surgery. However, subsequent to the surgery, upon analysis by the Department of Pathology, the mass was identified as an ovarian granulosa cell tumor (GCT). These tumors occur rarely, representing only 2-3% of all ovarian tumors, and are well known for late recurrences, with an incidence of 25-30%. As metastasis of the liver with GCT is extremely rare and the data available on the subject is limited by the small number of studies, and due to the absence of a biopsy report prior to surgery, the patient was initially misdiagnosed with PLC. However, despite this misdiagnosis, a good result was obtained, as the patient was later diagnosed with GCT following a detailed pathological examination and was treated with rational therapy. The performance status and quality of life were significantly improved, and the patient remains disease-free at one year post-surgery.

Keywords: granulosa cell tumor; liver; metastasis; ovary.

Figure 1

(A) Contrast-enhanced CT of the abdomen showing an enhancing mass (arrow) in the right half of the liver prior to surgery. (B) Delayed-phase CT of the abdomen showing a mass (arrow) of homogeneous lower attenuation in the right half of the liver prior to surgery. (C) Contrast-enhanced CT of the abdomen showing that the mass was no longer present in the right hemi-liver post-operatively. CT, computed tomography.

Figure 2

(A) Microscopic findings showing the structure of Call-Exner bodies (arrow) in the tumor tissue of the right hemi-liver. Immunohistochemistry in the tumor tissue of the right hemi-liver was (B) cluster of differentiation (CD)56(+), (C) CD99(+), (D) α-inhibin(+), (E) S-100(+) and (F) cytokeratin19(−) by EnVision staining procedures.