Background: Granulosa cell tumors (GCTs) of the ovary are low grade ovarian malignancies with a predilection for late recurrences in the pelvic cavity and occasionally distant metastases. Fine needle aspiration (FNA) can be used to detect such recurrences accurately based on unique cytologic and immunohistochemical features.
Case: A 5-cm, retrocaval mass at the level of the kidneys was detected in a 63-year-old woman who had a diagnosis of adult GCT (AGCT) of the ovary 18 years earlier and a local recurrence 5 years prior to this admission. The FNA of the retrocaval mass displayed small tumor cells with scant cytoplasm arranged in small aggregates and isolated cells. Coffee bean-like longitudinal nuclear grooves and microfollicular structures with amorphous material resembling Call-Exner bodies were not readily identified. Cytohistologic correlation with the patient's previous biopsies and positive immunohistochemical staining reaction with estrogen receptor, progesterone receptor and inhibin confirmed the recurrence of AGCT, thus avoiding unnecessary surgical interventions for diagnostic purposes.
Conclusion: For accurate interpretation of cytologic findings of recurrent GCT, proper clinical history, cytohistologic correlation with prior biopsies and a positive immunohistochemical reaction with inhibin are of vital importance.