Recurrence of a granulosa cell tumor resected by laparoscopic surgery: A case report

Management of a recurrent ovarian tumor often requires multiple surgical procedures. However, repeated abdominal surgery can be a burden for the patient both physically and psychologically. A 45 year old nulligravida underwent a left abdominal salpingo-oophorectomy due to an ipsilateral ovarian cystic tumor; the tumor was subsequently diagnosed histologically as a granulosa cell tumor (GCT). She was referred to our hospital due to an incidentally-detected right ovarian cystic tumor one year after the first surgery. A laparoscopic right salpingo-oophrectomy and hysterectomy was performed out because a recurrent GCT was suspected. However, the right ovarian cyst was found to be benign by histologic diagnosis. One year and 10 months after the second surgery, a solid peritoneal tumor was found on the right abdominal wall. The tumor was well-demarcated, and was resected laparoscopically. One year and four months after the third surgery, a well demarcated tumor was detected anterior to the rectum. The tumor was located at the vaginal cuff, and was resected laparoscopically. The third and fourth tumors were histopathology confirmed as a GCT recurrence. She is currently undergoing three consecutive chemotherapy cycles with pepleomycin, etoposide, and cisplatin. It is known that ovarian GCT can recur repeatedly over a period of years, and the standard treatment is surgery. Therefore, recurrent GCT patients often endure multiple surgical procedures and are exposed to the risk of acute and chronic surgical complication. Laparoscopic surgery is usually is not recommended for ovarian tumors suspicious of malignancy; however, adopting a laparoscopic approach to minimize surgical damage might be appropriate for selected cases, such as recurrent GCT.