PMC5106525_01
19-year-old woman with juvenile granulosa cell tumor. Contrast-enhanced coronal CT image demonstrating a large, multi-lobulated, low attenuation abdomino-pelvic mass arising from the right ovary.
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CT scan with oral and intravenous contrast was initially performed and showed a large, multi-lobulated, predominantly low-attenuation mass with numerous septations of varying thickness in the abdomen and pelvis measuring approximately 27 x 22 x 15 cm (Figure 1, Figure 2).
19-year-old woman with juvenile granulosa cell tumor. Contrast-enhanced axial CT image demonstrating the multi-lobulated heterogeneous mass with visible intraabdominal ascites.
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CT scan with oral and intravenous contrast was initially performed and showed a large, multi-lobulated, predominantly low-attenuation mass with numerous septations of varying thickness in the abdomen and pelvis measuring approximately 27 x 22 x 15 cm (Figure 1, Figure 2).
19-year-old woman with juvenile granulosa cell tumor. Ultrasound image of the abdomen/ pelvis demonstrating a large complex, cystic and solid mass with septations of varying thicknesses.
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This re-demonstrated the large pelvic mass, which appeared complex with both cystic and solid components (Fig. 3).
19-year-old woman with juvenile granulosa cell tumor. Photograph demonstrating the excised right ovarian mass in our patient, measuring 21 x 27 x 15 cm.
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An exploratory laparotomy found a 27 x 21 x 15 cm right ovarian cystic and solid mass (Fig. 4).
19-year-old woman with juvenile granulosa cell tumor. Photograph of the cut gross specimen demonstrating heterogeneous internal architecture with solid, cystic, hemorrhagic and necrotic components.
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The cystic portions had ragged, hemorrhagic internal surfaces (Fig. 5).
19-year-old woman with juvenile granulosa cell tumor. A,Photomicrograph on high power demonstrates anaplastic granulosa cells with dense granular chromatin and abundant eosinophilic cytoplasm with indistinct borders. Numerous mitotic figures and significant nuclear anaplasia are present. B, Photomicrograph on medium power demonstrates the solid component of the tumor containing irregular, rudimentary follicles of varying sizes separated by sheets of cells with high mitotic activity. Fibrous septations course through solid areas.
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The solid areas contained cells with round nuclei with granular nuclear chromatin, abundant eosinophilic cytoplasm with indistinct borders, and areas of extensive necrosis (Fig. 6A). Branching fibrous fronds are present throughout the lesion (Fig. 6B).
19-year-old woman with juvenile granulosa cell tumor. Contrast-enhanced axial CT imaging demonstrating recurrent pelvic disease despite chemotherapy less than 1 year after diagnosis.
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Additionally, new small loculated fluid collections are now clearly present in the right adnexa suggesting recurrent pelvic disease (Fig. 7).