A case of adult granulosa cell tumor presenting as thoracic lesions

Kosuke Suzuki; Akihiko Kitami; Momoka Okada; Shinnosuke Takamiya; Shinichi Ohashi; Yoko Tanaka; Shugo Uematsu; Tetsuo Nemoto; Mitsutaka Kadokura

doi:10.1186/s44215-023-00038-1

A case of adult granulosa cell tumor presenting as thoracic lesions

Gen Thorac Cardiovasc Surg Cases. 2023 Apr 21;2(1):14. doi: 10.1186/s44215-023-00038-1.

Authors

Kosuke Suzuki¹, Akihiko Kitami², Momoka Okada², Shinnosuke Takamiya², Shinichi Ohashi², Yoko Tanaka², Shugo Uematsu², Tetsuo Nemoto³, Mitsutaka Kadokura²

Affiliations

¹ Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan. k-suzuki@med.showa-u.ac.jp.
² Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Japan.
³ Department of Pathology and Laboratory Medicine, Showa University Northern Yokohama Hospital, Yokohama, Japan.

Abstract

Background: Granulosa cell tumors (GCTs) are uncommon sex cord-stromal ovarian neoplasms. We report a case of GCT presenting in the chest, 18 years after oophorectomy for ovarian cystadenocarcinoma.

Case presentation: A 63-year-old female was admitted to our hospital for evaluation of a right hilar lesion. Subsequent abdominal and pelvic computed tomography and brain magnetic resonance imaging were unremarkable. Eighteen years earlier, the patient had undergone total abdominal hysterectomy with bilateral salpingo-oophorectomy at another institution for a uterine myoma, with the pathological findings indicating a uterine myoma, dermoid cyst of the right ovary, and serous cystadenocarcinoma and endometrioid adenoacanthofibroma around hemorrhagic cyst of the left ovary. No indication of a granulosa cell tumor (GCT) was present in either ovary. As such, diagnostic video-assisted thoracoscopic surgery was performed, revealing a well encapsulated tumor located next to the inferior pulmonary vein and small, disseminated lesions on the chest wall and diaphragm. Thereafter, we performed resection of the main tumor in its entirety and the disseminated lesions to the extent possible. Pathological examination of the resected specimens revealed a neoplasm characterized by sheets and islands of closely packed tumor cells exhibiting small follicles (Call-Exner bodies) surrounded by cells with pale, uniform nuclei, typically observed in the microfollicular pattern of adult GCT. Although the etiology of occurrence of intrathoracic granulosa cell tumor is unknown, we assumed that the neoplasm oriented from radiologically undetectable peritoneal seeding at the time of her previous surgery, with subsequent migration through the diaphragm. Over the next 10 years, she received chemotherapy with cyclophosphamide, adriamycin, and cisplatin; other combination chemotherapy; single-agent chemotherapy; and palliative radiotherapy. She died from malignant pleuritis and peritonitis 10 years after thoracoscopic surgery.

Conclusions: We have reported a case of a 63-year-old female with a history of ovarian cystadenocarcinoma who underwent resection of a pleural neoplasm, which turned out to be a granulosa cell tumor. This possibility resulted from dissemination of a previous abdominal lesion.

Keywords: Granulosa cell tumor; Ovarian cyst adenocarcinoma; Pleural lesions.