Cytologic features of ascitic metastasis from a granulosa cell tumor

Abstract

Previous history of the patient is sometimes very helpful in cytologic diagnosis. We report a case of peritoneal metastasis of an adult-type granulosa cell tumor (AGCT) of the ovary, forming ascitic fluid. The patient was a 58-year-old woman who was diagnosed with a granulosa cell tumor of the ovary 13 years previously. She admitted to the hospital because of 3 days of lower abdominal pain. Several masses were in the lower abdominal cavity as well as culdesac, measuring 7.0 cm in maximum length in computerized tomography (CT) scan. Aspiration cytology of ascitic fluid demonstrated irregular sheets, loose aggregates or tight clusters of small, relatively uniform neoplastic cells with round or oval nuclei and scant cytoplasm. Nuclear grooves and indentations were noted in a small number of cells. Tumor cells arranged in follicular pattern mimicking Call-Exner bodies were identified. The cytopathologic diagnosis of the ascitic fluid was made to be a metastatic granulosa cell tumor. Although the granulosa cell tumor is the most common malignant sexcord stromal tumor, practically, they comprise only 2-3% of all ovarian tumors. Because of rarity of the disease and presentation in the metastatic sites, the diagnosis of AGCT may not be easy. An understanding the quiet characteristic cytological features, such as monotonous cells, microfollicular pattern, and nuclear grooving, is necessary to avoid false diagnoses of a recurrent neoplastic lesion by aspiration cytology.