Precocious puberty in a 20-month-old girl secondary to an ovarian juvenile granulosa cell tumor: a case report

Juvenile granulosa cell tumors (JGCTs) are extremely rare ovarian neoplasms, accounting for a small fraction of pediatric ovarian tumors. Their hormonal activity often manifests as precocious puberty, which may be the first sign of the disease. We report the case of a 20-month-old girl presenting with persistent vaginal bleeding for one month. She was born at term by cesarean section after an uncomplicated pregnancy, with an unremarkable medical history. Her mother reported breast development starting six months earlier. On examination, the patient appeared in good general condition, with Tanner stage II breast and pubic hair development and no clitoromegaly. Abdominopelvic ultrasonography revealed a large mixed solid–cystic right ovarian mass measuring 68 × 60 mm with intralesional fluid and uterine enlargement. Pelvic MRI confirmed an 80-mm right ovarian mass with both solid and cystic components and no locoregional invasion or abnormal vascular flow. Laboratory tests showed elevated estradiol (68 pg/mL; normal < 62 pg/mL), lactate dehydrogenase (269 U/L; normal < 200 U/L), and inhibin B (985 pg/mL; normal < 200 pg/mL), with normal human chorionic gonadotropin, progesterone, and alpha-fetoprotein levels. The patient underwent right salpingo-oophorectomy to ensure complete excision and to avoid potential tumor cell spillage or future complications., and histopathological examination confirmed a juvenile granulosa cell tumor. Postoperative follow-up over five months showed complete resolution of symptoms and no recurrence. Ovarian juvenile granulosa cell tumors must be promptly ruled out in females who present precocious puberty.