A Case of Recurrent Ovarian Adult Granulosa Cell Tumor: Ureter Resection and Ureteroneocystostomy

Abstract

Ovarian adult granulosa cell tumors (AGCTs) constitute 2-5% of all ovarian cancers. Long-term patient follow-up is important because it tended to late recurrence. Complimentary staging surgery was performed on the patient who was diagnosed with AGCTs after oophorectomy was performed due to an ovarian cyst at the age of 42 in 2014 at the external center. Adjuvant chemotherapy BEP (Bleomycin, Etoposide, Cisplatin) was given to the patient. The patient, who was operated on for pelvic recurrence after 36 months at an external center, was reported as a recurrence of the postoperative pathology of AGCTs and then received salvage chemotherapy (Carboplatin-Paclitaxel). In the follow-up after recurrence surgery, a few masses of 85x65 mm, solid, multicystic, enhancing in the pelvis were identified in the computed tomography at 36 months. Bilateral ureters were reported as dilated with mass compression. Thereupon, an operation decision was made for the patient. Preoperative tumor markers were normal. In the intraoperative observation, an approximately 10 cm hard fixed tumoral mass extending from the left paracolpium surrounding the ureter to the levator anterior, densely attached to the bladder and invading the obliterated umbilical artery was observed. This mass was dissected from the levator muscle with the bladder, the entrance of the left ureter into the bladder was closed and the ureter was cut, and the mass was removed. The right ureter was observed by entering the right retroperitoneum and it was found to be intact. A double-J catheter was placed in the left ureter. The bladder dome was opened and the bilateral ureter orifice was observed. Ureteroneocystostomy was performed by anastomosing the left ureter to the dome of the bladder. No residual tumor was left after surgery. The patient, who had no problem in the follow-up, was discharged on the 7th postoperative day. Pathology of the patient Upon the arrival of AGCTs, medical oncology and radiation oncology were consulted for salvage chemotherapy and pelvic radiotherapy.Multifocal disease and incomplete resection of recurrent disease in AGCT recurrence are associated with reduced overall survival. In the recurrence of AGCTs, it should be aimed not to leave visible tumors in salvage cytoreduction.