Background: Androgen-producing granulosa cell tumors (GCTs) are rare but should be suspected in patients presenting with rapid onset virilization and a large cystic adnexal mass. Preoperative diagnosis is difficult. By ultrasound, completely cystic, estrogen-producing GCTs are uncommon, while 39% of reported androgenic GCTs are completely cystic. We report a case of a GCT presenting with virilization and initially characterized on 3-dimensional (3-D) ultrasound.
Case: A 32-year-old woman, gravida 1 para 0010, presented with amenorrhea, rapid onset hirsutism, acne, a 15-lb (6,803 g) weight gain, and an 8.7-cm cystic adnexal mass. The mass was evaluated with 2-D ultrasound and characteristics were confirmed on 3-D ultrasound. No abnormal Doppler flow was noted. Initial laboratory values confirmed hyperandrogenemia. A laparoscopic right salpingo-oophorectomy was performed after thorough counseling, and pathology demonstrated an adult granulosa cell tumor. Postoperatively her androgen levels normalized and symptoms resolved within 6 weeks. She continues to pursue pregnancy.
Conclusion: Presentations of androgen-producing ovarian masses are rare; however, the possibility of an androgenic GCT should be considered in the presentation of a large, virilizing, cystic adnexal mass to facilitate appropriate counseling and management.