the average modal age of menopause is 51 years . it has changed little since centuries ( classical , medieval , and modern period ) . age of menopause is independent of socio - economic state , race , height , weight , and nutritional status . one of the rare causes of late menopause is granulosa cell tumor of the ovary . here , we report a case of granulosa cell tumor of ovary in a perimenopausal lady who presented with menorrhagia . a 52-year - old multiparous woman presented with complaints of menorrhagia . on examination , uterus was found to be bulky and fornices were free . the hysteroscopy findings were thick endometrium and histopathology was reported as simple hyperplasia of the endometrium . however , the microscopic picture showed granulosa cell tumor ( call - exner bodies ) of the right ovary , left ovary being normal . patient recovered well after the procedure and was advised to follow - up with serum inhibin b every 3 months till 2 years and annually life long , thereafter . granulosa cell tumor ( gct ) of the ovary is a rare neoplasm accounting for approximately 1.5 - 3% of all ovarian malignancies . they can be either juvenile ( 5% ) or of the adult ( 95% ) type . microscopically , gcts are composed of granulosa cells , theca cells , and fibroblasts in varying amounts . there are four different types of ovarian sexcord tumors namely , granulosa cell tumors , fibroma , thecoma , and fibrothecoma depending upon the histological origin . adult gcts have multiple histomorphologies , including well - differentiated and less welldifferentiated types . the well - differentiated group is composed of microfollicular , macrofollicular , trabecular , and insular pattern [ figure 1 ] . microfollicular is the most common pattern and contains the characteristic call - exner bodies [ figure 2 ] . these bodies consist of small rings of granulosa cells surrounding eosinophilic fluid and basement membrane material . adult gcts showing cytoplasmic vacuoles , prominent nucleoli , mitosis , and necrosis are suggestive of aggressive behavior . this tumor produces estrogen , and this is the reason for early diagnosis . the most common endocrine manifestation in the perimenopausal and menopausal age group is abnormal uterine bleeding . patients can also have breast tenderness and increased vaginal secretion from estrogenic stimulation of the breast and vaginal tissues , respectively . patients are also at an increased risk of breast cancer although a direct correlation is difficult to prove . after menopause , elevated estrogen suppresses fsh and these women often do not complain of vasomotor symptoms . macrofollicular pattern of granulosa cells call - exner bodies and nuclear grooves this case highlights the fact that cases of dysfunctional uterine bleeding may be because of an estrogen secreting tumor of the ovary and hence , importance must be given to the accurate imaging of the ovaries . most commonly , they appear as round to ovoid masses that are multicystic with solid components in the center or periphery . the preoperative work up should also include mammography as these women are at increased risk for breast cancer due to the excess estrogen production . apart from the regular tumor markers , several other tumor markers have been evaluated in patients with gcts including inhibin . although inhibin a and inhibin b levels can both be elevated in patients with gcts , inhibin b levels are usually elevated in a higher proportion of these tumors . studies of inhibin in patients with gcts have shown that levels are elevated preoperatively and return to reference range postoperatively . serum inhibin levels are also used for long - term follow - up of patients with lead time from elevation of inhibin to clinical recurrence being 11 months . granulosa cell tumors are staged surgically following the 1987 figo classification same as that of other ovarian carcinomas . gcts of more advanced stage are associated with 5 and 10 years survival rates of 33 - 44% . tumor stage at the time of initial surgery is the most important prognostic variable . besides stage , chan et al . , found age younger than 50 , smaller tumor size , and absence of residual disease to be statistically significant factors in predicting survival . despite the relatively indolent nature and favorable prognosis of most gcts , late recurrences are not a rare event even in stage i patients , hence patients must be educated about the need for long - term follow - up . surveillance for patients postoperatively consists of frequent pelvic examinations and assessment of tumor markers to detect recurrences as early as possible . recurrences can often be treated effectively by another surgical procedure followed by chemotherapy or radiation therapy , to which some adult granulosa cell tumors have been very sensitive . recently , aromatase inhibitors have shown promising results in the treatment of recurrent granulosa cell tumors . currently , anti - mullerian hormone ( amh ) has been shown to be a circulating marker specifically for gct . its diagnostic performance seems to be very good , with a sensitivity ranging between 76 and 93% . in patients treated for gct , amh may be used postoperatively as marker for the efficacy of surgery and for disease recurrence . in conclusion , a patient presenting in the perimenopausal period must be evaluated very thoroughly for possible malignancy of the genital tract and breasts . in all patients presenting with delayed menopause , the possibility of a granulosa cell tumor
a 52-year - old patient presented with complaints of menorrhagia . 
 endometrial biopsy revealed simple hyperplasia of the endometrium . 
 total abdominal hysterectomy with bilateral oophorectomy was carried out . 
 the ovaries looked grossly normal , but histopathology reported granulosa cell tumor of the right ovary . 
 granulosa cell tumors belong to the sexcord stromal category and account for approximately 2% of all ovarian tumors . 
 we review the features and treatment of granulosa cell tumors and the importance of screening for ovarian tumors in a case of endometrial hyperplasia and delayed menopause .