Presentation
Suprapubic abdominal pain, dysuria, and post-menopausal bleeding.
Patient Data
CASE OF THE MONTH: This case was selected as the Case of the Month for January 2024.
The uterus is displaced to the left of the pelvis by a large heterogeneous mass lesion. Posterior to this mass, there is a similar-appearing discrete lesion that appears to be abutting the larger lesion. Both masses have high T1/T2 signals, having a multiloculated/multiseptated appearance. They demonstrate a high T1 signal and a high signal on FS T1 images, indicating a large blood product component.
These changes are accompanied by multifocal solid components, which are low on both T1/T2 sequences. No signal dropped out to suggest calcification. There is no evidence of fat within the lesions.
The patient underwent a hysterectomy with a bilateral salpingo-oophorectomy.
Histopathology
The tumor cells are seen arranged in microfollicles and macrofollicles. Classical Call-Exner bodies are noted in many of the sections. The morphological appearances are fully consistent with the diagnosis of an adult granulosa cell tumor.
Case Discussion
An adult granulosa cell tumor is an infrequent gynecological malignancy. It is a subcategory of ovarian neoplasms and has a 5% proportion of malignant ovarian cancer.
They can present a plethora of radiological findings, such as solid masses or tumors, which can have hemorrhagic, fibrotic, cystic, and/or multilocular cystic characteristics.
In this case, the latter is present, which follows a macrofollicular arrangement containing hemorrhagic components. They are usually encompassed by the ovary at the time of discovery.
Case contributors:
Dr. Delilah Trimmer, Consultant Radiologist
Dr. Sarah Johnson, Consultant Radiologist
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