Granulosa Cell Tumor Causing Endometrial Adenocarcinoma in Postmenopausal Woman: A Case Report

Introduction Endometrial cancer (EC) is the sixth most common malignant cancer in the world. 580 new cases are detected in Lithuania every year [1]. EC has two types of which endometrioid Type 1 (G1, G2) has a hormonal driven etiology [2]. On the contrary, adult granulosa cell tumor (AGCT) is a relatively rare subtype of ovarian cancer (OC), accounting for 2-4% of all EC [3]. It is usually diagnosed during perimenopause or early menopause [3]. AGCT causes an abnormal estrogen secretion, long-term often causing endometrial changes [3]. This provokes an abnormal vaginal bleeding - the most common symptom of AGCT [3]. Long-term exposure to endogenous estrogen may lead to endometrial hyperplasia or carcinoma [4, 5, 6]. Case Presentation A 59 year-old female was consulted for pathological vaginal bleeding after menopause. Uterine biopsy was performed. Most data were found for endometrium of irregular proliferation. Pelvic MRI showed endometrium measuring 20 mm. After further examination hysteroscopy and uterine abrasion were recommended but patient refused. A month later patient was reconsulted complaining about episodic vaginal bleeding. Ultrasound revealed that the endometrium thickened to 28mm. This time previously suggested procedures were planned. Operation results showed endometrium of irregular proliferation with focal atypical hyperplasia of the endometrium and growth of endometrioid adenocarcinoma (EA) G1. After radiological staging total laparoscopic hysterectomy with bilateral adnexectomy and sentinel lymph node biopsy were performed. Pathohistological examination results identified not only EA but an AGCT as well. Existence of AGCT was not anticipated during medical examination nor the surgery. Discussion Due to their rarity AGCT might be not considered as a primary cause of the symptoms and lead to misdiagnosis. Conclusions Although rare, AGCT should not be excluded as a cause of EA.