Yayuan Zhou

Adult granulosa cell tumor of the ovary incidentally discovered and ruptured during cesarean section: A case report

Rationale: Ovarian granulosa cell tumor is a rare sex cord-stromal malignancy (2%–5% of ovarian carcinomas). Its diagnosis and management become particularly challenging when this tumor is associated with pregnancy and complicated by intraoperative rupture. Patient concerns: A 40-year-old multiparous woman underwent emergency cesarean section for fetal distress at 39 weeks. A previously unidentified 2 cm left ovarian cyst was discovered and incidentally ruptured during cystectomy. Diagnoses: Histopathology analysis revealed the diffuse nests of monomorphic cells exhibiting nuclear grooves and Call-Exner bodies. Immunohistochemistry analysis was positive for FOXL2, inhibin, and vimentin, confirming adult granulosa cell tumor classified as International Federation of Gynecology and Obstetrics IC1. Interventions: Initial cystectomy was performed. The patient subsequently underwent a postpartum fertility-sparing, including laparoscopic staging procedure, which included left salpingo-oophorectomy and omentectomy; no residual disease was identified. Outcomes: No evidence of recurrence was detected during follow-up. The patient retained fertility potential and declined adjuvant therapy. Lessons: Systematic adnexal evaluation during cesarean sections is essential for detecting occult ovarian neoplasms, emphasizing the importance of multidisciplinary collaboration and accessible intraoperative frozen section analysis, particularly in resource-limited settings.