Koganezawa Itsuki, Tomita Koichi, Nakagawa Masashi, Ozawa Yosuke, Kobayashi Toshimichi, Sano Toru, Tsutsui Rina, Chiba Naokazu, Okimura Akira, Nakatsugawa Munehide, Hirano Hiroshi, Kawachi Shigeyuki
Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
Department of Diagnostic Pathology, Tokyo Medical University Hachioji Medical Center, 1163 Tatemachi, Hachiojishi, Tokyo, 193-0998, Japan.
Surg Case Rep. 2020 Jun 3;6(1):125. doi: 10.1186/s40792-020-00880-3.
Granulosa cell tumor (GCT) is a type of ovarian sex cord-stromal tumor with low-grade malignancy, which can recur long after primary resection. All reports on GCTs in the liver describe cases of metastases, while there are no previous reports of primary GCTs originating from the liver. We report a case of GCT, with recurrence of liver metastasis long after ovariectomy, which was subsequently resected by a right trisectionectomy.
A 76-year-old woman presented with a history of surgical resection of an ovarian tumor performed 30 years previously; no details of the tumor were available. When she was 68 years old, an abdominal ultrasound revealed a small liver mass, which was diagnosed as a hepatic hemangioma with slow growth. Outpatient follow-up was discontinued for 5 years, and the patient was not examined again until the age of 76 years. At this point, the tumor had substantially increased in size, and surgical resection was required owing to suspicion of malignancy. The patient was then referred to our hospital. Contrast-enhanced computed tomography (CT) showed a large tumor, approximately 18 cm in size, occupying the right lobe and medial section of the liver. After percutaneous transhepatic portal vein embolization, a right trisectionectomy was performed. The histopathological findings of the resected specimen showed that the tumor cells had "coffee bean-like" nuclear grooves, which are characteristic of a GCT. Acidophilic non-structural Call-Exner bodies were also observed. Inhibin-α, CD99, and CD56 markers of sex cord-stromal tumors were detected on immunohistological examination; all pathology suggested a GCT. We considered the tumor to be a liver metastasis of a previous ovarian GCT that was resected 30 years prior by ovariectomy. There was no recurrence for > 15 months after the hepatectomy.
We report a case of a GCT in the liver, which was identified to be a liver metastasis. Right trisectionectomy was subsequently performed for tumor resection. Clinicians should be aware that ovarian GCTs may recur in the liver, and that GCT recurrence may occur long after ovariectomy of the primary ovarian GCT.
颗粒细胞瘤（GCT）是一种低度恶性的卵巢性索间质肿瘤，在初次切除后很长时间仍可能复发。所有关于肝脏颗粒细胞瘤的报道均描述为转移病例，此前尚无原发性肝脏颗粒细胞瘤的报道。我们报告一例颗粒细胞瘤病例，该病例在卵巢切除术后很长时间出现肝转移复发，随后接受了右半肝切除术。
一名76岁女性，有30年前卵巢肿瘤手术切除史，肿瘤具体细节不详。68岁时，腹部超声发现肝脏有一个小肿块，诊断为生长缓慢的肝血管瘤。门诊随访中断5年，直到76岁患者才再次接受检查。此时，肿瘤体积已大幅增大，因怀疑恶性而需要手术切除。患者随后转诊至我院。增强计算机断层扫描（CT）显示一个约18厘米大小的大肿瘤，占据肝脏右叶和中叶。经皮经肝门静脉栓塞后，进行了右半肝切除术。切除标本的组织病理学检查结果显示，肿瘤细胞有“咖啡豆样”核沟，这是颗粒细胞瘤的特征。还观察到嗜酸性无结构的Call-Exner小体。免疫组织学检查检测到性索间质肿瘤的抑制素-α、CD99和CD56标志物；所有病理结果均提示为颗粒细胞瘤。我们认为该肿瘤是30年前卵巢切除的既往卵巢颗粒细胞瘤的肝转移。肝切除术后超过15个月无复发。
我们报告一例肝脏颗粒细胞瘤病例，经鉴定为肝转移。随后进行了右半肝切除术以切除肿瘤。临床医生应意识到卵巢颗粒细胞瘤可能在肝脏复发，且在原发性卵巢颗粒细胞瘤卵巢切除术后很长时间仍可能发生颗粒细胞瘤复发。
