Giant myoma associated with uterine prolapse during the second trimester of twin pregnancy: case report

Abstract

Background: Granulosa Cell tumors (GCT) are a sex-cord stroma tumor comprising of 1-2% of ovarian malignancies. Derived from Schwann cells, GCTs are comprised of granulosa cells, a cell of the ovarian stroma. Patients with these tumors present with signs of increased estrogen such as vaginal bleeding, irregular menstruation and rarely hirsutism and virilization.8,10-12 The majority of GCTs are found in the skin, subcutaneous tissue and submucosa with a handful of case reports discussing primary GCTs in the clitoris.3,7 Surgery is required for definitive tissue diagnosis and staging. In this case report, we present a case with tissue diagnosis for granulosa cell tumor found on the clitoral hood. Case: A 56-year-old, female, G6P3033 initially presented for evaluation of persistent clitoral cyst for >2 years Initial evaluation was significant for 1 cm clitoral cyst that was firm, smooth and fluctuant with no irregular borders; with worsening vulvodynia. The patient underwent clitoral hood mass excision. The mass was excised entirely and the post-operative recovery was uncomplicated. Pathology findings were significant for completely excised granulosa cell tumor; margins were negative for tumor. Immunohistochemical stain was positive for CD56, CD68, Vimentin, and S-100, and negative for AE1/13, CD31, CD34, SMA, and Desmin. Conclusion: When evaluating chronic, persistent, or recurrent masses, it is important to take into consideration both benign and malignant causes. Definitive diagnosis is established pathologically. Patients with confirmed GCT should be thorough evaluated pre-operatively with blood work and appropriate imaging. Upon diagnosis, patient with GCT should be regularly followed for recurrence and surveillance.