Stage I Ovarian Granulosa Cell Tumor Found Alongside Colon and Adrenal Cancers

What happened, in summary

A 48-year-old woman presented with 2 weeks of severe lower abdominal pain, swelling and bloating. CT imaging showed a large complex pelvic mass measuring up to 18 cm as well as a separate right adrenal mass. She underwent exploratory surgery with removal of the pelvic mass, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic lymph-node dissection and omentectomy. Pathology showed that the ovarian mass was a 19 × 18 × 14 cm granulosa cell tumor. Four lymph nodes from each side of the pelvis were negative for metastasis, and final staging was Stage I. The operation also revealed a sigmoid colon cancer, and pathology confirmed a separate adrenal carcinoma. These were distinct synchronous primary cancers rather than spread from the ovarian tumor. No radiation was recommended for the ovarian disease. More than 2 years after diagnosis, the patient was doing well with no sites of recurrence or metastatic disease. She continued gynecologic oncology follow-up, including CT scans every 6 months and inhibin levels every 3 months. At that follow-up, there was no evidence of recurrent or metastatic ovarian cancer.