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Review
. 2023 Mar 30;17(1):135.
doi: 10.1186/s13256-023-03793-5.

Granulosa tumor: two spontaneous pregnancies after combined medico-surgical treatment: case report and review of the literature

Mohamed Kaakoua  1 , Jean Chidiac  2 , Andrianandrasana Notf  2 , Ruiqian Chen  3 , Isabelle Mahe  2 , Sadji Djennaoui  2
Affiliations
Review

Granulosa tumor: two spontaneous pregnancies after combined medico-surgical treatment: case report and review of the literature

Mohamed Kaakoua et al. J Med Case Rep. .

Abstract

Background: Granulosa tumor is a rare tumor that arises from the mesenchyme and the sexual cord of the ovary. The prognosis is generally excellent, and treatment is mainly based on surgery, followed by chemotherapy depending on the extension of the disease. However, "the obstetrical prognosis" is compromised.

Case presentation: We report the case of a 32-year-old Caucasian patient who was diagnosed during a primary infertility assessment with an ultrasound image of a 39 mm organic left ovarian cyst confirmed on pelvic magnetic resonance imaging with infiltration of the uterosacral space. Tumor markers, including cancer antigen 125, alpha fetoprotein, and β-human chorionic gonadotropin, were normal. Histological study of biopsies of the ovarian lesion taken during exploratory laparoscopy confirmed the diagnosis of adult granulosa tumor. After a normal extension assessment including a thoracoabdominopelvic computed tomography scan and a positron emission tomography scan, the patient underwent complete conservative surgery and the disease was classified as stage Ic. Three cycles of adjuvant chemotherapy according to the "BEP" protocol combining bleomycin, etoposide, and cisplatin were performed after oocyte cryopreservation. After a 5-year follow-up period, the patient had no sign of tumor progression and had two spontaneous pregnancies, the first occurring 3 months after the end of chemotherapy and the second 14 months later.

Conclusion: Granulosa cell tumor remains a rare tumor whose management considerably compromises fertility and reduces the chances of having a spontaneous pregnancy. The particularity of our observation is that the diagnosis of the granulosa tumor was made following a primary infertility assessment and that the patient had two spontaneous pregnancies 3 months after the end of a medico-surgical treatment known to be very gonadotoxic.

Keywords: Case report; Granulosa tumor; Obstetric prognosis; Pregnancy; Therapeutic.

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Conflict of interest statement

The authors declare that they have no competing interest.

Figures

Fig. 1
Fig. 1
Ultrasound image showing an organic left ovarian mass measuring 39 mm
Fig. 2
Fig. 2
Pelvic MRI showing the presence of a left ovarian mass. A Sagittal slice in T1 sequence, B axial slice in T1 sequence, C axial slice after injection of gadolinium
Fig. 3
Fig. 3
Tumor proliferation of diffuse and microfollicular architecture (×100)
Fig. 4
Fig. 4
Cell with central notch, coffee bean (×400). Arrow corresponds to the coffee bean pattern in granulosa cell tumors
See this image and copyright information in PMC

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