What happened, in summary

A 64-year-old woman came to the emergency department with left flank pain and was found to have a large mass in the left upper abdomen. She had undergone hysterectomy and removal of both ovaries and fallopian tubes 22 years earlier, but after such a long interval she could no longer recall the diagnosis that had led to the original operation and had been lost to follow-up.

Imaging showed a roughly 10 cm tumor in the left perirenal area, with possible involvement of nearby organs. Before surgery, the origin was uncertain. She underwent maximal debulking that included removal of the spleen, the distal pancreas, part of the left adrenal gland, and part of the diaphragm. Pathology and immunohistochemical testing confirmed that the mass was a metastatic granulosa cell tumor, establishing a very late recurrence of her previous ovarian cancer.

Her experience is notable for the exceptionally long 22-year interval between initial treatment and metastatic recurrence, emphasizing the long natural history that can occur with ovarian granulosa cell tumors.