EP25.11: Rare virilising granulosa cell tumour in an adolescent: ultrasonographic and MRI diagnostics, clinical features and treatment

Abstract

Objectives:The aim was to assess the clinical usefulness and diagnostic performance by additional measurement of CA 125 in combination with ultrasound findings for preoperative assessment of adnexal masses. Methods: This was a retrospective study assessing 215 adnexal masses in 215 women pre-and postmenopausal over a 24-month period in Gynecological Oncology Unit. Seventy-three (34%) women were premenopausal and 142 (66%) women were premenopausal. Patients were evaluated with transvaginal ultrasound according to the Gynecologic Imaging Report and Data System (GI-RADS) classification. Serum concentration of CA 125 was measured before surgical procedure. The definitive diagnosis was confirmed by pathological examination of the excised lesions. Ovarian cancer is the fifth more common type of cancer in women and the forth cause of cancer death in women. Gynecological ultrasound is one of the main investigation methods that allows the identification and detailed description of pelvic adnexal masses at first, because of its potential in reconstructing highly definitive images and its simple application, although it is an extremely operator dependent technique.A 67 year old woman was referred to our gynecological consultation because of lower abdominal pain and a suspected right ovarian cancer.By transvaginal ultrasound and Colour Doppler imaging a solid mass in the retrouterine area was found, dimension of 78x44x40mm, adherent to the posterior face of the uterus and to the right ovarium. Part of the mass, 4 cm diameter, was seen to be intensely vascularised; the remaining part wasn't and it was suspected to be a fecaloma. It was evaluated through the IOTA international scale. The ultrasound examination showed a positive sliding sign. The vascularised mass was indeed suspected to be originating from the lower part of the bowel, the inner layer of the sigma. The mass had been surgically resected, as well as the anterior part of the rectum and the uterus with the adnexals on both sides. The diagnosis was of lower bowel Adenocarcinoma, poorly differentiated, G3, and ulcerate.Transvaginal ultrasound and Colour Doppler allow detailed study of the pelvic organs and both play a central role in differential diagnosis of pelvic undifferentiated masses. Moreover, it provides proper and accurate tools for surgical pre operation evaluation.Supporting information can be found in the online version of this abstract Hormone-producing malignancies are rare in children or adolescent patients: Only 0.1% of all ovarian tumours and 45% of granulosa cell tumours occur in the sexually non-active ages. Granulosa cell tumours (GCTs) are sex cord-stromal tumours of the ovary, representing 78% of all ovarian neoplasms. A total of 95% of all GCTs are adult-type, and only 5% are diagnosed as juvenile-type GCT. A majority of children with juvenile-type GCT present with isosexual precocious pseudopuberty due to excessive estrogen production, although virilising, testosterone-producing, juvenile-type GCTs are rare, occurring only in 2% of cases. We ...