Juvenile granulosa cell tumor in a teenager: a case report

Juvenile granulosa cell tumors (JGCTs) are rare ovarian sex cord–stromal neoplasms that primarily affect young females and are often detected early due to hyperestrogenic manifestations. A 17-year-old female with a history of seizures and hypothyroidism presented with a 5-month history of intermittent abdominal pain, nausea, anorexia, and constant lower-back discomfort associated with progressive abdominal distention. Physical examination revealed marked abdominal distention with striae. Laboratory studies demonstrated elevated lactate dehydrogenase (LDH) and alkaline phosphatase (ALP), as well as beta-human chorionic gonadotropin (β-hCG). An abdominopelvic computed tomography (CT) scan revealed a 35.7 × 26 × 19.1 cm predominantly cystic adnexal mass with eccentric solid components and no evidence of ascites or lymphadenopathy. Tumor markers, including alpha-fetoprotein (AFP) and carcinoembryonic antigen (CEA), were negative. Surgical exploration via periumbilical incision revealed a large cystic mass arising from the left adnexa. Controlled decompression with a Veress needle allowed safe mobilization of the tumor, yielding 4.8 L of cystic fluid that was sent for cytological evaluation. The mass was then excised from the abdominal cavity, and a left salpingo-oophorectomy was performed. Pathology confirmed a JGCT with an intact capsule, classified as stage IA according to the Federation of Gynecology and Obstetrics (FIGO) criteria. Postoperatively, the patient recovered well and remained asymptomatic, with no recurrence during a 3-year follow-up period. JGCT should be considered as a differential diagnosis of large ovarian tumors in adolescents, even in the absence of hormonal manifestations.