PMC9678695_01
A 6-cm cystic-solid mass was detected in the right ovary by MRI. A mass was located in the right ovary (thin arrows), exhibiting iso-intensity on FS-T1WI (A), iso- and hyper-intensity on axial FS-T2WI (B), sagittal FS-T2WI (C), and coronal T2WI (D). The mass shows hyper-intensity on DWI (E), and contrast enhancement (F-H).
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In addition, the endometrium was unevenly enhanced (Fig. 1).
A 20-cm cyst mass was detected on pelvic MRI 2 months later. The cyst mass exhibits hypointensity on FS-T1WI (A), and hyperintensity on FS-T2WI (B), sagittal FS-T2WI (C), and coronal T2WI (D). A little solid component was found in the periphery, which shows hyper-intensity on DWI (E), and contrast enhancement (F-H).
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T1WI, hyperintense signal on T2WI and hypointense signal on DWI, with the mean ADC value of 0.95 x 10-3 mm2/s. The solid component still showed obvious enhancement, which was consistent with that 2 months ago, and the surrounding structures were compressed and displaced (Fig. 2).
Ultrasound findings in different time points of the mass. The mass showed mixed echoes, with a clear boundary, and uneven internal echoes at first, and the mesh-echolic zone was visible (A). Two months later, the mass showed a dominantly anechoic mixed zone.
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The patient had proceed ultrasound and also revealed the change of volume (Fig. 3).
Representative H&E and IHC staining of the mass. Granulosa cell tumors have small cells with little cytoplasm. Tumor cells have less atypia and little mitosis (A, x100). There are multiple large and thick blood vessels around the tumor (B, x200). Ki 67 shows 10% of the nucleus with deep staining (C, x100). The inhibin-stained cytoplasm is blue (D, x100).
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Immunohistochemistry for the markers of GCT revealed the following: Inhibin (+), CD99 (partly +), Calretinin (partly +), CD10 (-), Vim (+), Des (-), EMA (-), and Ki67 (10%+) (Fig. 4).