Pseudo-precocious puberty secondary to Juvenile Granulosa cell tumour in a 30-month-old female toddler: A case report

Background: Precocious puberty is rare globally and its incidence in Nigeria is unknown, as few reported cases exist. Case presentation: We report a 30-month-old female toddler with abnormal vaginal bleeding and breast enlargement of three months duration, with associated pubic and axillary hair. Height increase and unusual temper tantrums were also noticed. She had a 2-year history of steroid-containing cream use. The unrelated parents had normal puberty. There was no similar history in the siblings. Her height was 94 cm (97th centile) and weighed 12 kg (50th centile). There were no café-au-lait spots. Breast development and pubic hair both corresponded to Tanner Stage 2. A firm mass was palpated in the lower abdominal region. A pelvic magnetic resonance imaging scan revealed a round heterogenous mass with multiple focal cystic areas in the left pelvic cavity. Bone age was normal. Serial oestradiol levels were elevated. Tumor markers were within normal ranges. The cytological analysis of excised tissues during exploratory laparotomy with left oophorectomy revealed Call-Exner bodies which are pathognomonic for granulosa cell tumours. She has remained stable after the surgery. Discussion and conclusion: This case report highlights the importance of considering and investigating rare causes of pseudo-precocious puberty in pre-pubertal girls.