Successful pregnancy outcome with a large ruptured juvenile granulosa cell tumor: A case report

Abstract

Background: Juvenile granulosa cell tumors (JGCTs) are rare sex cord stromal tumors diagnosed
mainly in premenarchal girls and women younger than 30 years.

Case presentation: A 19-year-old primigravida at 36 weeks of gestation presented to the labor ward with
complaints of generalized abdominal pain, headaches, and reduced fetal movements for two days.
Ultrasound revealed a left-sided 15.7 by 15 cm large cyst and a solid mass of increased vascularity with
maternal ascites. The biophysical profile of the fetus was 4/8 (no movement or tone but the presence of
respiration and amniotic fluid). An emergency exploratory laparotomy was performed, and intraoperative
findings revealed a massive torsed right ovary with a ruptured ovarian mass with grossly edematous and

necrosed fallopian tubes. Following a safe cesarean section delivery of the fetus, a right salpingo-
oophorectomy with cystectomy was performed. The histopathological results confirmed the diagnosis of

JGCT FIGO stage IC2. Postoperatively, the patient was treated with six sessions of chemotherapy
(cisplatin and paclitaxel). Post-chemotherapy magnetic resonance imaging showed normal abdominal
viscera with minimal free fluid in the posterior cul de sac and a normal left ovary. Inhibin B levels dropped
to 3.17, and the patient is on follow-up for the next 5 years with repeated tumor marker testing and
computed tomography scans.
Conclusion: JGCT is a very uncommon pregnancy tumor, and aggressive treatment is necessary for
advanced-stage tumors such as the one in this case to prevent recurrence or even death.