Ovarian Granulosa Cell Tumor Spreads to the Spine and Kidney

What happened, in summary

A 44-year-old woman had first presented at age 36 with an acute abdomen. Surgery removed the left ovary and fallopian tube, with lymph node dissection and omentectomy. Pathology showed a 20 cm granulosa cell tumor of the left ovary. Adjuvant chemotherapy was planned but postponed when she became pregnant, and she later delivered without complications.

She remained under surveillance for several years. In 2010, severe lower back pain led to imaging and biopsy of the L1 vertebra, confirming metastatic granulosa cell tumor. The spinal metastasis was treated with radiation.

Further follow-up showed increasing inhibin B levels and progressive changes in the left kidney. By July 2012, imaging showed a large mass replacing much of the kidney, and she had severe back pain and vaginal bleeding. A left radical nephrectomy was performed. Pathology showed a large benign cystic nephroma containing a 5 cm solid nodule of metastatic granulosa cell tumor. The case therefore documented late distant spread of the ovarian tumor to both the spine and kidney.