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Metastasis of the liver with a granulosa cell tumor of the ovary: A case report

Metastasis of the liver with a granulosa cell tumor of the ovary: A case report ONCOLOGY LETTERS 9: 816-818, 2015 Metastasis of the liver with a granulosa cell tumor of the ovary: A case report 1 1 2 1 3 1 SHUIPING YU ,  XUELING ZHOU ,  BINZONG HOU ,  BO TANG ,  JIE HU and  SONGQING HE Department of General Surgery, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000;  Department of General Surgery, The Fifth Affiliated Hospital of Sun  Yat‑Sen University, Zhuhai, Guangdong 519000;  Department of Pathology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000, P.R. China Received May 10, 2014; Accepted November 14, 2014 DOI: 10.3892/ol.2014.2784 Abstract. The present study describes the case of a 62 year-old palpable mass (1). GCTs have a low malignant potential and female patient with a metastatic tumor in the right hemi-liver of a strong tendency for late recurrences, with an incidence of >25 cm in diameter, who presented to The Affiliated  Hospital  25‑30%. However, hepatic metastases are rare and account for  of Guilin Medical University (Guangxi, China) with acute only 5-6% of all GCT recurrences (2,3). These rare metastases abdominal pain and severe malnutrition. Radical surgery was usually occupy a wide region of the liver parenchyma as a performed to remove the tumor by open surgery. A biopsy was result of their large size and may be identiefi d  by microscopy  not performed prior to the surgery, so the tumor was diagnosed due to the presence of Call‑Exner bodies (4). The first  case was  as end-stage primary liver cancer (PLC) based solely on the reported in the English literature Margolin et al in 1985 (5). As character and appearance of the tumor on computed tomog- few studies and little data are available on the subject of metas- raphy prior to surgery. However, subsequent to the surgery, upon  tasis in the liver with a GCT of the ovary, a metastasis occurring analysis by the Department of Pathology, the mass was identiefi d   from GCT of the ovary can easily be misdiagnosed as end-stage as an ovarian granulosa cell tumor (GCT). These tumors occur PLC, for which surgery may not necessarily be performed, rarely, representing only 2-3% of all ovarian tumors, and are leading to a deteriorative pathogenetic condition. Resectioning well known for late recurrences, with an incidence of 25-30%. liver metastases for GCTs is usually performed only as a pallia- As metastasis of the liver with GCT is extremely rare and the tive procedure rather than as a therapeutic plan, however it may data available on the subject is limited by the small number signicfi antly  improve the quality of life for the patient (6). The  of studies, and due to the absence of a biopsy report prior to present study reports the case of a patient in whom surgery for surgery, the patient was initially misdiagnosed with PLC. GCT of the ovary was performed >20 years prior to recurrence, However, despite this misdiagnosis, a good result was obtained,  following which, a second surgery was performed that resulted as the patient was later diagnosed with GCT following a detailed in a signicfi antly  improved quality of life. The patient provided  pathological examination and was treated with rational therapy. written informed consent. The performance status and quality of life were signicfi antly   improved, and the patient remains disease-free at one year Case report post-surgery. A 62‑year‑old female was admitted to The Affiliated  Hospital  Introduction of Guilin Medical University (Guilin, China) in 2013 with acute abdominal pain and severe malnutrition. Previously, Granulosa cell tumors (GCTs) are rare sex cord-stromal tumors, in 1986, at 35 years of age, the patient had undergone a total and are classiefi d  into either adult or juvenile forms and the  abdominal hysterectomy and bilateral salpingo-oophorectomy median age at presentation, for the adult form is 50 years. GCTs (TAH+BSO) for a stage 1 grade 1 adult GCT of the ovary in  are low-grade neoplasms, whose early symptoms are uterine the Second Hospital of Guangxi Province (Guilin, China). The  bleeding and pain, in addition to pressure symptoms with a patient did not receive any adjuvant chemotherapy and remained disease-free until 2013. Upon admittance to hospital in 2013, the blood test for the α-fetoprotein (AFP) tumor marker was negative. A computed tomography (CT) scan of the patient was performed and reviewed. A 2.5-mm slightly enhancing Correspondence to:  Professor  Songqing  He,  Department  of  mass was observed in the tumor of metastasis; the tumor was General  Surgery,  The  Affiliated  Hospital  of  Guilin  Medical  ~10x15x25 cm in size (Fig. 1). A biopsy was not obtained prior University, 15 Lequn Road, Guilin, Guangxi 541000, P.R. China to surgery. Following the diagnosis of right PLC, surgery was E‑mail: 478517575@qq.com performed. Recurrences were present on the right hemi-liver Key words: metastasis, liver, granulosa cell tumor, ovary and jejunum, with sparse nodules. A radical hepatectomy involving segments 5/6, a cholecystectomy and a segmental jejunectomy were performed. Following the resection, the YU et al:  METASTASIS OF THE LIVER WITH A GRANULOSA CELL TUMOR OF THE OVARY Figure 1. (A) Contrast‑enhanced CT of the abdomen showing an enhancing mass (arrow) in the right half of the liver prior to surgery. (B) Delayed‑phase CT of  the abdomen showing a mass (arrow) of homogeneous lower attenuation in the right half of the liver prior to surgery. (C) Contrast-enhanced CT of the abdomen showing that the mass was no longer present in the right hemi-liver post-operatively. CT, computed tomography. Figure 2. (A) Microscopic findings  showing the structure of Call‑Exner bodies (arrow) in the tumor tissue of the right hemi‑liver. Immunohistochemistry in  the tumor tissue of the right hemi‑liver was (B) cluster of differentiation (CD)56(+), (C) CD99(+), (D) α‑inhibin(+), (E) S‑100(+) and (F) cytokeratin19(‑) by  EnVision staining procedures. tissues were delivered to the Department of Pathology, and then are the presence of Call-Exner bodies as microfollicular embedded in paraffin  and sectioned. The pathological results  structures on microscopy, and immunohistochemistry results showed Call-Exner bodies as microfollicular structures and showing positive CD56, CD99, inhibin-α and S-100 staining, clear metastasis of the liver, with GCT of the ovary (Fig. 2). but negative CK19 staining. GCTs are generally low-grade Immunhistochemistry results revealed positivite staining for  neoplasms associated with a long disease-free interval due CD56, CD99, inhibin-α and S-100 and nega tive staining for to the indolent nature of the disease, however, the majority of CK19. The patient made a good recovery, with resolution of the patients must be manage their condition and be aware of new previous abdominal pain, and remains disease-free at one year symptoms, as the tumors are well known late recurrences, post-surgery. which occur with an incidence of 25‑30% (4). Hepatic metas- tases rarely occur, with an incidence of 5-6% of all GCT Discussion recurrences (7). The occurrence of these metastases in only  one segment is also rare, as they are almost always large in Ovarian cancer has the fifth  highest mortality rate of all cancers  size and occupy a wide region of the liver parenchyma (8). in females, after breast, bowel, lung and uterine cancer, repre- It may be difcfi ult  to differentiate GCT from PLC prior  senting 5‑6% of cancer‑related mortalities (2). In total, 85%  to surgery. In the present study, the patient underwent a  of ovarian cancers arise from the ovarian surface epithelium; TAH+BSO for stage 1 grade 1 GCT in 1986, and no adju- sex cord-stromal tumors account for 2-5% overall, with GCT vant chemotherapy was administered. The patient remained being the most common (3). The main characteristics of GCT disease-free for >20 years until recurrence, which presented ONCOLOGY LETTERS 9: 816-818, 2015 References as abdominal pain and a large mass in the liver. Consequently,  it is important that patients with GCT should be followed 1. Koukourakis GV, Kouloulias VE, Koukourakis MJ,  et al: up regularly, even if the disease-free interval is long, and Granulosa cell tumor of the ovary: tumor review. Integr Cancer  that adjuvant treatments may be reserved for patients with Ther 7: 204‑215, 2008. large residual or inoperable tumors. The literature on GCTs 2. Redman C, Duffy S and Dobson C: Improving early detection of  ovarian cancer. Practitioner 255: 27‑30, 33, 2011. commonly advocates the use of radiofrequency ablation for  3. Pectasides D, Pectasides E and Psyrri A: Granulosa cell tumor hepatic metastases from GCT (9‑11). Historically, surgical  of the ovary. Cancer Treat Rev 34: 1-12, 2008. resection of liver metastases for GCT was performed merely 4. Hasiakos D, Papakonstantinou K, Karvouni E and Fotiou S:  Recurrence of granulosa cell tumor 25 years after initial as a palliative procedure, and not as a planned intervention, diagnosis. Report of a case and review of the literature. Eur J even though it resulted in a signicfi ant  increase in disease‑free  Gynaecol Oncol 29: 86-88, 2008 survival (6). We believe that the surgical resection of hepatic  5. Margolin KA, Pak HY, Esensten ML and Doroshow JH:  Hepatic metastasis in granulosa cell tumor of the ovary. Cancer  metastases for GCT is necessary, particularly in patients who 56: 691-695, 1985. experience a long period of disease-free survival following the 6. Madhuri TK, Butler‑Manuel S, Karanjia N and Tailor A: Liver  primary surgery. Although the surgery has certain risk factors, resection for metastases arising from recurrent granulosa cell tumour of the ovary - a case series. Eur J Gynaecol Oncol 31: patients may make a good recovery, with resolution of any 342-344, 2010. previous discomfort, and resulting in another long disease-free   7. Rose PG, Piver MS, Tsukada Y and Lau TS: Metastatic period post-operatively. patterns in histologic variants of ovarian cancer. An autopsy study. Cancer 64: 1508-1513, 1989. In the present study, the patient initially presented in  8. Lordan JT, Jones RL, Karanjia ND and Butler‑Manuel S:  2013 with acute abdominal pain and severe malnutrition. A Debulking hepatectomy for an unusual case of a grade 1 biopsy was not performed prior to surgery. A metastatic tumor stage 1 granulosa cell tumour of the ovary with late metastases. Oncology 72: 143‑144, 2007. with a maximum diameter of >25 cm was detected, and even 9. Bojalian MO, Machado GR, Swensen R and Reeves ME:  though the mass was misdiagnosed as a PLC, surgery was Radiofrequency ablation of liver metastasis from ovarian  performed to remove the tumor. The patient made a good adenocarcinoma: case report and literature review. Gynecol Oncol 93: 557‑560, 2004. recovery and remains disease-free at present. 10. Taira Y, Hirakawa M, Nagayama C, Ikemiyagi K, Touma T and  Although the present reported case is rare, it indicates the role Tokashiki M: Successful treatment of adult-type granulosa cell of surgical resection for hepatic metastases of GCT, particularly tumor of the ovary by palliative radiotherapy. J Obstet Gynaecol Res 38: 461-465, 2012. in patients with a record of a long disease-free period. Doctors, 11. Jacobs IA, Chang CK and Salti G: Hepatic radiofrequency  and specicfi ally  hepatobiliary surgeons, should be aware that  ablation of metastatic ovarian granulosa cell tumors. Am patients with GCT should be regularly followed up, even if the Surg 69: 416-418, 2003. disease‑free interval is long. Hepatic resection for GCT may  signicfi antly  improve a patient's survival time and quality of life. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Oncology Letters Pubmed Central

Metastasis of the liver with a granulosa cell tumor of the ovary: A case report

Oncology Letters , Volume 9 (2) – Dec 9, 2014

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Pubmed Central
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Copyright © 2015, Spandidos Publications
ISSN
1792-1074
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1792-1082
DOI
10.3892/ol.2014.2784
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Abstract

ONCOLOGY LETTERS 9: 816-818, 2015 Metastasis of the liver with a granulosa cell tumor of the ovary: A case report 1 1 2 1 3 1 SHUIPING YU ,  XUELING ZHOU ,  BINZONG HOU ,  BO TANG ,  JIE HU and  SONGQING HE Department of General Surgery, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000;  Department of General Surgery, The Fifth Affiliated Hospital of Sun  Yat‑Sen University, Zhuhai, Guangdong 519000;  Department of Pathology, The Affiliated Hospital of Guilin Medical University, Guilin, Guangxi 541000, P.R. China Received May 10, 2014; Accepted November 14, 2014 DOI: 10.3892/ol.2014.2784 Abstract. The present study describes the case of a 62 year-old palpable mass (1). GCTs have a low malignant potential and female patient with a metastatic tumor in the right hemi-liver of a strong tendency for late recurrences, with an incidence of >25 cm in diameter, who presented to The Affiliated  Hospital  25‑30%. However, hepatic metastases are rare and account for  of Guilin Medical University (Guangxi, China) with acute only 5-6% of all GCT recurrences (2,3). These rare metastases abdominal pain and severe malnutrition. Radical surgery was usually occupy a wide region of the liver parenchyma as a performed to remove the tumor by open surgery. A biopsy was result of their large size and may be identiefi d  by microscopy  not performed prior to the surgery, so the tumor was diagnosed due to the presence of Call‑Exner bodies (4). The first  case was  as end-stage primary liver cancer (PLC) based solely on the reported in the English literature Margolin et al in 1985 (5). As character and appearance of the tumor on computed tomog- few studies and little data are available on the subject of metas- raphy prior to surgery. However, subsequent to the surgery, upon  tasis in the liver with a GCT of the ovary, a metastasis occurring analysis by the Department of Pathology, the mass was identiefi d   from GCT of the ovary can easily be misdiagnosed as end-stage as an ovarian granulosa cell tumor (GCT). These tumors occur PLC, for which surgery may not necessarily be performed, rarely, representing only 2-3% of all ovarian tumors, and are leading to a deteriorative pathogenetic condition. Resectioning well known for late recurrences, with an incidence of 25-30%. liver metastases for GCTs is usually performed only as a pallia- As metastasis of the liver with GCT is extremely rare and the tive procedure rather than as a therapeutic plan, however it may data available on the subject is limited by the small number signicfi antly  improve the quality of life for the patient (6). The  of studies, and due to the absence of a biopsy report prior to present study reports the case of a patient in whom surgery for surgery, the patient was initially misdiagnosed with PLC. GCT of the ovary was performed >20 years prior to recurrence, However, despite this misdiagnosis, a good result was obtained,  following which, a second surgery was performed that resulted as the patient was later diagnosed with GCT following a detailed in a signicfi antly  improved quality of life. The patient provided  pathological examination and was treated with rational therapy. written informed consent. The performance status and quality of life were signicfi antly   improved, and the patient remains disease-free at one year Case report post-surgery. A 62‑year‑old female was admitted to The Affiliated  Hospital  Introduction of Guilin Medical University (Guilin, China) in 2013 with acute abdominal pain and severe malnutrition. Previously, Granulosa cell tumors (GCTs) are rare sex cord-stromal tumors, in 1986, at 35 years of age, the patient had undergone a total and are classiefi d  into either adult or juvenile forms and the  abdominal hysterectomy and bilateral salpingo-oophorectomy median age at presentation, for the adult form is 50 years. GCTs (TAH+BSO) for a stage 1 grade 1 adult GCT of the ovary in  are low-grade neoplasms, whose early symptoms are uterine the Second Hospital of Guangxi Province (Guilin, China). The  bleeding and pain, in addition to pressure symptoms with a patient did not receive any adjuvant chemotherapy and remained disease-free until 2013. Upon admittance to hospital in 2013, the blood test for the α-fetoprotein (AFP) tumor marker was negative. A computed tomography (CT) scan of the patient was performed and reviewed. A 2.5-mm slightly enhancing Correspondence to:  Professor  Songqing  He,  Department  of  mass was observed in the tumor of metastasis; the tumor was General  Surgery,  The  Affiliated  Hospital  of  Guilin  Medical  ~10x15x25 cm in size (Fig. 1). A biopsy was not obtained prior University, 15 Lequn Road, Guilin, Guangxi 541000, P.R. China to surgery. Following the diagnosis of right PLC, surgery was E‑mail: 478517575@qq.com performed. Recurrences were present on the right hemi-liver Key words: metastasis, liver, granulosa cell tumor, ovary and jejunum, with sparse nodules. A radical hepatectomy involving segments 5/6, a cholecystectomy and a segmental jejunectomy were performed. Following the resection, the YU et al:  METASTASIS OF THE LIVER WITH A GRANULOSA CELL TUMOR OF THE OVARY Figure 1. (A) Contrast‑enhanced CT of the abdomen showing an enhancing mass (arrow) in the right half of the liver prior to surgery. (B) Delayed‑phase CT of  the abdomen showing a mass (arrow) of homogeneous lower attenuation in the right half of the liver prior to surgery. (C) Contrast-enhanced CT of the abdomen showing that the mass was no longer present in the right hemi-liver post-operatively. CT, computed tomography. Figure 2. (A) Microscopic findings  showing the structure of Call‑Exner bodies (arrow) in the tumor tissue of the right hemi‑liver. Immunohistochemistry in  the tumor tissue of the right hemi‑liver was (B) cluster of differentiation (CD)56(+), (C) CD99(+), (D) α‑inhibin(+), (E) S‑100(+) and (F) cytokeratin19(‑) by  EnVision staining procedures. tissues were delivered to the Department of Pathology, and then are the presence of Call-Exner bodies as microfollicular embedded in paraffin  and sectioned. The pathological results  structures on microscopy, and immunohistochemistry results showed Call-Exner bodies as microfollicular structures and showing positive CD56, CD99, inhibin-α and S-100 staining, clear metastasis of the liver, with GCT of the ovary (Fig. 2). but negative CK19 staining. GCTs are generally low-grade Immunhistochemistry results revealed positivite staining for  neoplasms associated with a long disease-free interval due CD56, CD99, inhibin-α and S-100 and nega tive staining for to the indolent nature of the disease, however, the majority of CK19. The patient made a good recovery, with resolution of the patients must be manage their condition and be aware of new previous abdominal pain, and remains disease-free at one year symptoms, as the tumors are well known late recurrences, post-surgery. which occur with an incidence of 25‑30% (4). Hepatic metas- tases rarely occur, with an incidence of 5-6% of all GCT Discussion recurrences (7). The occurrence of these metastases in only  one segment is also rare, as they are almost always large in Ovarian cancer has the fifth  highest mortality rate of all cancers  size and occupy a wide region of the liver parenchyma (8). in females, after breast, bowel, lung and uterine cancer, repre- It may be difcfi ult  to differentiate GCT from PLC prior  senting 5‑6% of cancer‑related mortalities (2). In total, 85%  to surgery. In the present study, the patient underwent a  of ovarian cancers arise from the ovarian surface epithelium; TAH+BSO for stage 1 grade 1 GCT in 1986, and no adju- sex cord-stromal tumors account for 2-5% overall, with GCT vant chemotherapy was administered. The patient remained being the most common (3). The main characteristics of GCT disease-free for >20 years until recurrence, which presented ONCOLOGY LETTERS 9: 816-818, 2015 References as abdominal pain and a large mass in the liver. Consequently,  it is important that patients with GCT should be followed 1. Koukourakis GV, Kouloulias VE, Koukourakis MJ,  et al: up regularly, even if the disease-free interval is long, and Granulosa cell tumor of the ovary: tumor review. Integr Cancer  that adjuvant treatments may be reserved for patients with Ther 7: 204‑215, 2008. large residual or inoperable tumors. The literature on GCTs 2. Redman C, Duffy S and Dobson C: Improving early detection of  ovarian cancer. Practitioner 255: 27‑30, 33, 2011. commonly advocates the use of radiofrequency ablation for  3. Pectasides D, Pectasides E and Psyrri A: Granulosa cell tumor hepatic metastases from GCT (9‑11). Historically, surgical  of the ovary. Cancer Treat Rev 34: 1-12, 2008. resection of liver metastases for GCT was performed merely 4. Hasiakos D, Papakonstantinou K, Karvouni E and Fotiou S:  Recurrence of granulosa cell tumor 25 years after initial as a palliative procedure, and not as a planned intervention, diagnosis. Report of a case and review of the literature. Eur J even though it resulted in a signicfi ant  increase in disease‑free  Gynaecol Oncol 29: 86-88, 2008 survival (6). We believe that the surgical resection of hepatic  5. Margolin KA, Pak HY, Esensten ML and Doroshow JH:  Hepatic metastasis in granulosa cell tumor of the ovary. Cancer  metastases for GCT is necessary, particularly in patients who 56: 691-695, 1985. experience a long period of disease-free survival following the 6. Madhuri TK, Butler‑Manuel S, Karanjia N and Tailor A: Liver  primary surgery. Although the surgery has certain risk factors, resection for metastases arising from recurrent granulosa cell tumour of the ovary - a case series. Eur J Gynaecol Oncol 31: patients may make a good recovery, with resolution of any 342-344, 2010. previous discomfort, and resulting in another long disease-free   7. Rose PG, Piver MS, Tsukada Y and Lau TS: Metastatic period post-operatively. patterns in histologic variants of ovarian cancer. An autopsy study. Cancer 64: 1508-1513, 1989. In the present study, the patient initially presented in  8. Lordan JT, Jones RL, Karanjia ND and Butler‑Manuel S:  2013 with acute abdominal pain and severe malnutrition. A Debulking hepatectomy for an unusual case of a grade 1 biopsy was not performed prior to surgery. A metastatic tumor stage 1 granulosa cell tumour of the ovary with late metastases. Oncology 72: 143‑144, 2007. with a maximum diameter of >25 cm was detected, and even 9. Bojalian MO, Machado GR, Swensen R and Reeves ME:  though the mass was misdiagnosed as a PLC, surgery was Radiofrequency ablation of liver metastasis from ovarian  performed to remove the tumor. The patient made a good adenocarcinoma: case report and literature review. Gynecol Oncol 93: 557‑560, 2004. recovery and remains disease-free at present. 10. Taira Y, Hirakawa M, Nagayama C, Ikemiyagi K, Touma T and  Although the present reported case is rare, it indicates the role Tokashiki M: Successful treatment of adult-type granulosa cell of surgical resection for hepatic metastases of GCT, particularly tumor of the ovary by palliative radiotherapy. J Obstet Gynaecol Res 38: 461-465, 2012. in patients with a record of a long disease-free period. Doctors, 11. Jacobs IA, Chang CK and Salti G: Hepatic radiofrequency  and specicfi ally  hepatobiliary surgeons, should be aware that  ablation of metastatic ovarian granulosa cell tumors. Am patients with GCT should be regularly followed up, even if the Surg 69: 416-418, 2003. disease‑free interval is long. Hepatic resection for GCT may  signicfi antly  improve a patient's survival time and quality of life.

Journal

Oncology LettersPubmed Central

Published: Dec 9, 2014

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